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During the last decade 452 patients have undergone pelvic lymphadenectomy as a staging procedure for apparently localized prostatic cancer. Of these patients 105 (23 per cent) had pelvic node metastasis. Node involvement occurred in no patient with a stage A1, 24 per cent with stage A2, 12 per cent with stage B1, 28 per cent with stage B2 and 53 per cent with stage C tumor. Correlation with tumor grade revealed nodal metastasis in 10 per cent of the patients with well differentiated tumors, 24 per cent with moderately differentiated lesions and 54 per cent with poorly differentiated tumors. The incidence of positive nodes is low enough to preclude lymphadenectomy in patients with stage A1 (0 per cent) and well differentiated stage B1 tumors (4 per cent), and high enough to assume metastatic disease without lymphadenectomy in those with poorly differentiated stage C tumors (93 per cent). All other patients with apparently localized prostatic cancer should undergo a staging pelvic node dissection before definitive treatment.

Patients with stage A2 carcinoma of the prostate are a heterogeneous population and not all of them progress to clinically manifest disease. We found a similar variability in terms of the pathological findings in a group of 34 patients with stage A2 disease undergoing pelvic lymphadenectomy and radical prostatectomy. While 8 patients (24 per cent) had metastatic disease on staging lymphadenectomy, 9 patients (27 per cent) had negative lymphadenectomy, with minimal or no residual tumor in the radical specimen. The histologic grade and extent of tumor on transurethral resection did not predict reliably patients with stage A2 disease and minimally invasive cancer at radical prostatectomy. It appears that present criteria for separating stage A tumors into focal and diffuse categories are adequate for selecting therapy for patients with incidental carcinoma of the prostate.