ABSTRACT

In this era of serum prostate-specific antigen (PSA), which has been revolutionary in the early diagnosis of prostate cancer since 1987, the frequency of positive pelvic lymph nodes at radical prostatectomy dropped remarkably from 21% in 1987 to 2% in 19991. The decrease has occurred largely because of stage migration to a greater prevalence of low-stage cancers from the finding at diagnosis of progressively smaller cancers. A minor, unmonitored but possibly contributing factor could be less extensive node dissections as the period ensued. Nevertheless, lymph node-positive disease is now encountered much less often. However, in the course of any radical prostatectomy, the preliminary finding of metastasis to one or more pelvic lymph nodes (N+ disease) is widely recognized to be associated with additional systemic disease2,3. At one time, it was reported that ‘no patient with pelvic lymph node metastasis has survived free of tumor for >5 years,2,4.