Lymph node metastases are found in approximately 15% of patients treated by radical prostatectomy (RP). Although nodal involvement is clearly a poor prognostic sign, it is not an inevitable harbinger of recurrence: about one in three patients with positive lymph nodes remain recurrence free at long-term follow-up even in the absence of post-operative treatment.1 This suggests prognostic heterogeneity in men with positive lymph nodes that should be taken into consideration in order to avoid overtreatment.