Dilemma of microscopic lymph node metastases in human prostate cancer

During radical surgical procedures for prostatic carcinoma, lymph node metastases are not infrequently discovered unexpectedly. Microscopic lymph node metastases, on the other hand, are generally overlooked and identified first by routine histology following surgery. In both these situations there is some controversy about how to proceed therapeutically. When lymph node metastases are discovered during radical prostatectomy, many authors favor discontinuing surgery, which is associated with a high morbidity, and then start the patient on hormonal treatment. This approach, however, is not favored by all investigators. When microscopic lymph node metastases are reported, the complexity of the situation increases. The various dilemmas posed to urologists when confronted with lymph node metastases are discussed.