The lymph node positive prostate cancer. A case for radical prostatectomy

Lymph node positive carcinoma of the prostate (stage pN + /D1) is generally considered to be systemic disease that cannot be cured by radical prostatectomy. Treatment options in these minimally metastasized tumors are the wait and watch stategy, hormonal therapy, radiotherapy and radical prostatectomy alone or in combination. At present, there are no prospective randomized trials available regarding the value of these treatment modalities. In retrospective studies, the results of radical prostatectomy seem to be superior to conservative management. In several studies comparing radical prostatectomy vs. pelvic lymphadenectomy alone, a higher tumor burden in the lymphadenectomy alone groups is present. In general, radical prostatectomy reduces local complications of prostate carcinoma and improves quality of life. In conclusion, patients with single or low volume lymph node metastases as well as patients with low tumor grade or favorable Gleason score and diploid tumors seem to benefit from radical prostatectomy. However, the definitive role for radical prostatectomy has to be stated as uncertain.