Lymph node staging in clinically localized prostate cancer

Pelvic lymph node involvement is an adverse prognostic factor in clinically localized prostate cancer, and a knowledge of nodal status is important fo r patient management. Whereas nodal disease has been widely regarded as inc urable, evidence is now accumulating that some men with lymph node involvem ent may benefit from radical multimodality treatment approaches. Pelvic nod al status may be assessed by predictive nomograms, by imaging studies and b y surgery. The pros and cons of each method are discussed together with the prospects for future development. Optimal strategies combining the differe nt diagnostic approach:es for the detection of lymph node metastases are co nsidered in the context of the changing therapeutic implications of nodal d isease.