The systematic review supporting this guideline identified 44 studies (N=244,889 patients) detailing the outcomes of patients who variously did or did not undergo pelvic lymph node dissection (PLND) at the time of radical prostatectomy for clinically localized prostate cancer. Of note, the absence of robust prospective clinical trials comparing the results of patients undergoing PLND versus not, as well as significant methodological issues (e.g., heterogeneity in risk of harboring lymph node positive disease among the populations studied, lack of standardized dissection templates) and bias limit the level of evidence from the reported outcome data. That said, from the existing literature, no consistent benefit to PLND can be derived with regard to oncologic outcomes such as biochemical recurrence, metastasis-free, cancer-specific, and OS.183-188 Two prospective trials randomized patients undergoing radical prostatectomy to limited versus extended PLND.189, 190 In both trials, no statistically significant difference in subsequent biochemical recurrence-free survival was identified between the treatment arms, although one of the trials did note improved biochemical recurrence-free survival with extended lymph node dissection in an exploratory subgroup analysis of patients with Grade Group 3 to 5 tumors.189 At the same time, the systematic review did demonstrate a higher risk of adverse perioperative outcomes in patients undergoing PLND (operating time, blood loss, length of stay) and post-operative complications – most notably lymphocele.191 Nevertheless, as PLND (specifically, an extended PLND) does facilitate identification of positive nodes,189, 192 the Panel concluded that patients should be counseled regarding the staging benefit of PLND. Identifying positive nodes not only contributes to refined risk stratification/patient counseling, but may further be used to guide the selective application of secondary therapies.193, 194 Given the uncertain oncologic benefit and noted – albeit small – increased risk of complications with PLND, the Panel believes that PLND should be advised according to a risk stratified approach, using nomograms for risk assessment. Several nomograms exist to facilitate selection of patients for PLND.195-197 When selecting a model, it is important that clinicians consider the risk profile of the patients included in model development (e.g., percentage of high-risk patients) as well as the reference standard (e.g., extended versus limited PLND) utilized to establish the model’s predictive capacity. Existing national and organizational guidelines have proposed various thresholds of nomogram-predicted probability of lymph node positive disease for clinicians to perform a PLND at the time of radical prostatectomy. Recognizing varying individual risk tolerance, the Panel believes that the patient’s calculated risk of harboring positive nodes should be discussed along with the utility of establishing the presence of positive nodes to inform future management and the risks associated with PLND and to facilitate the SDM approach to performing lymph node dissection.