We present a comprehensive literature review and critical discussion of the diagnostic and therapeutic value of lymph node dissection in prostate cancer. Lymph node dissection is currently the most reliable staging procedure for detecting lymph node metastases in prostate cancer. Accuracy increases with the extent of the procedure. Overall, in patients with positive lymph nodes after radical prostatectomy and lymph node dissection, a favorable long-time cancer-specific survival can be observed. These data seem to be independent of the extent of the lymph node dissection and also independent of the administration of adjuvant therapy. It can be suspected that patients with lymph node metastases present different prognostic groups based on the extent of lymph node involvement. However, these risk groups might reflect only a lead-time bias, so the therapeutic value of lymph node dissection remains unclear. In conclusion, the therapeutic value of lymph node dissection in prostate cancer must be sufficiently evaluated in prospective clinical trials. Each patient should be individually counseled regarding his individual tumor features and the use of statistical prognostic tools such as nomograms.
