[The incidence of regional lymph node metastases in operable prostatic carcinoma (author's transl)]

Operation specimens of 165 radical prostatectomies were examined systematically for their pathological anatomy. In 22 cases (13.3%) there were metastases in the obturator and (or) iliac lymph nodes, in 12 cases these were micro-metastases with a maximal diameter of 2 mm. Ten were classified as N1, 7 ad N2 and 5 as N4. Lymph node involvement increased with increasing tumour staging: from 10% in T2 to 26.3% in T3. All metastasizing tumours had invaded the capsule (P3), 77% had additional infiltration of the seminal vesicles and in 73% the tumour volume was at least 50% that of the prostate. Thus prostate carcinoma must reach a certain size and penetrate the capsule before lymph node seeding occurs. The rate of metastases increases ninefold when the seminal vesicles are infiltrated. All metastasizing prostate cancers were polymorphic and in 73% the tumour differentiation in the metastases was identical. The findings as regards localisation of the tumour in the prostate and the metastases correlated in 91%. This result leads one to suspect a regular course of laterally localised spread in which the group of obturator lymph nodes appears to lie in the primary lymph drainage area of the prostate. The prognostic significance of regional lymph node metastases cannot yet be evaluated.