Despite the high frequency with which radical prostatectomy is used to treat prostate cancer, uncertainty exists regarding the merits of a simultaneous pelvic lymph node dissection. Unresolved issues include identifying the optimal candidate and selecting the appropriate surgical template, among others. In this article, the authors discuss the pros and cons of performing a pelvic lymph node dissection and the staging/diagnostic and therapeutic implications of this procedure. The lack of robust randomized clinical trials in the literature necessitates a careful analysis of retrospective and case series data.