Eighty-two of 307 consecutive staging lymphadenectomies had nodal metastases (Stage D1 prostate carcinoma). Seventy-seven of the 82 cases had at least a 5-year follow-up and 50 had at least a 10-year follow-up. Three of these 77 cases had Grade 1 (well-differentiated) metastases, 59 (77%) had Grade 2-3 (moderately differentiated) metastases, and 15 (19%) had Grade 4 (poorly differentiated) metastases (M. D. Anderson Hospital [MDAH] grading system). The patients with moderately differentiated metastases had 5-year and 10-year survival rates of 79% and 34%, respectively, whereas the patients with poorly differentiated metastases had 5-year and 10-year survival rates of 13% and 0%, respectively (P less than 0.0001). This study demonstrates a statistically significant difference between the prognosis of Stage D1 patients with moderately differentiated metastases and Stage D1 patients with poorly differentiated metastases. Consequently, the evaluation of the histologic appearance of Stage D1 metastases may be of clinical importance.