We performed a retrospective review of surgical pathology specimens and clinical data for all patients with node-positive prostate cancer diagnosed in our institutions between 1985 and 1994. We used adjusted actuarial survival analyses and univariate and multivariate analyses to evaluate the clinical significance of extracapsular perinodal tumor extension. Sixty patients with histologically confirmed prostate cancer metastatic to regional lymph nodes were reviewed. Forty-two patients (70%) had evidence of extracapsular extension of the tumor into perinodal tissue. The 5-year adjusted cumulative survival rates for patients with extracapsular nodal extension was 54.6%, compared with 71.4% for patients with histologically confined nodal metastases (P < .05). Univariate and multivariate analyses revealed the presence of extracapsular nodal tumor extension to be an independent predictor of patient survival. In this study, only the histologic grade (Gleason score) of the primary tumor was a stronger predictive factor. These data suggest that histologic evidence of extracapsular tumor extension from lymph node metastases into perinodal tissue might be an important prognostic factor in patients with node-positive adenocarcinoma of the prostate. Development of a pathologic substage to include this feature might be warranted.