Staging lymphadenectomy should be an antecedent to treatment in localized prostatic carcinoma.

Our own data, as well as those of many other workers, suggest that clinicians cannot depend on primary lesion Gleason scoring alone to predict the incidence of positive nodes in patients with prostatic cancer. We continue to find node involvement in 20 per cent or more of patients with Gleason 2 through 4 primary lesions. Furthermore, we continue to find that a large number (nearly 40%) of patients with Gleason 8 through 10 primary tumors do not have lymph node spread. Because of the significance of node status on patient prognosis and its potential impact on treatment decisions, we continue to advocate surgical lymph node staging in patients with localized prostate cancer.