[Lymphogenic metastases in prostatic cancer--operative and histopathologic investigations ]

The necessary application of a differentiated therapy for prostatic cancer requires the involvement of the N-category for determining the therapy. Hitherto existing statements on the lymphogenic metastases of this tumor have been made by means of method whose statements have been limited by the non-presentability of the pelvic lymph nodes, inflammatory-degeneratively changed lymph nodes, and micrometastases. The pelvic en-bloc-lymphadenectomy has been performed and the lymph nodes prepared in successive cuts in the light of a functional patient series of 93 prostatic cancer patients. The standardized procedure allowed statements on the distribution of the pelvic lymph nodes and the corresponding metastases, the size of the metastases and their histologic structure. In prostatic cancer is a high percentage of micrometastases. Lymphogenic metastases can already be detected in low tumor categories, on the other hand metastases are not obligatory in advanced tumors. There is no correlation between the histologic degrees of differentiation of the primary tumor and the lymphogenic metastases. Compared with the metastasis histology the primary tumor histology reveals a distinct morphologic change. According to present investigations, the lymphogenic metastases occur prior to the bone metastases. Since pelvic lymphogenic metastases cannot be covered exactly by means of the conventional methods as well as the metastases cannot be estimated in the single case, there is the necessity for making the pelvic en-bloc-lymphadenectomy before performing a localized tumor treatment such as prostatic vesiculectomy or tele cobalt therapy.