The prognostic role of lymphadenectomy in adenocarcinoma of the prostate.

Lymphatic extension to the pelvic nodes is best identified by pelvic lymphadenectomy, although pathologic grading of the prostatic primary lesion may allow identification of nodal extension in a small number of patients. The treatment data indicate that prostatic adenocarcinoma, as with virtually all other cancers, has limited potential for cure by local treatment when lymph node extension has occurred. Categorical statements promoting lymphadenectomy as a therapeutically beneficial procedure must be tempered by the observed adverse prognostic impact of identified nodal extension. Lymphadenectomy, as it has little therapeutic impact, should be used to select patients for treatments designed for control of localized disease. Patients with identified nodal extension might best be managed by design and application of a treatment regimen that has a systemic rather than a local or regional effect. It seems reasonable to conclude that pelvic node dissection in prostatic carcinoma offers limited therapeutic benefit and should be considered only as an aid in treatment selection.