Staging lymphadenectomy should not be an antecedent to treatment in localized prostatic carcinoma

The current controversy focusing on regional node evaluation in patients with prostatic carcinoma has been engendered by the enhanced biologic risk created by regional lymph node extension. The data indicate that node-positive disease is a systemic disorder and, as such, is not controlled by local treatment, such as lymphadenectomy combined with either radical removal of the primary malignancy or local radiation therapy. If lymphadenectomy is only prognostic and not therapeutic, it is reasonable to argue that any form of anatomic staging that permits the identification of nodal extension is a replacement for staging lymphadenectomy.