title: Nationwide prevalence of lymph node metastases in Gleason score 3 + 3 = 6 prostate cancer.
abstract: Based on revisions of Gleason scoring in 2005, it has been reported that nodal metastases at radical prostatectomy in Gleason 3 + 3 = 6 (GS6) prostate cancer are extremely rare, and that GS6 cancers with nodal metastases are invariably upgraded upon review by academic urological pathologists. We analysed the prevalence and determinants of nodal metastases in a national sample of patients with GS6 cancer.We utilised the SEER database to identify patients diagnosed with GS6 prostate cancer during 2004-2010 who had radical prostatectomy and ≥1 lymph node(s) examined. We calculated the prevalence of nodal metastases and constructed a multivariable logistic regression model to identify factors associated with nodal metastases. Among 21,960 patients, the prevalence of nodal metastases was 0.48%. Older age, preoperative PSA >10  ng/mL, and advanced stage were positively associated with nodal metastases. Lymph node metastases in GS6 cancer are more prevalent in a nationwide population compared to academic centres. Revised guidelines for Gleason scoring have made GS6 cancer a more homogeneously indolent disease, which may be relevant in the era of active surveillance. We submit that lymph node metastases in GS6 cancer be used as a proxy for adherence to the 2005 ISUP consensus on Gleason grading.
authors.affiliation: 1Department of Urology, Stanford University School of Medicine, Stanford 2Cancer Prevention Institute of California, Fremont 3Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jen-Jane
authors.initials: JJ
authors.lastname: Liu
authors.forename: Daphne Y
authors.initials: DY
authors.lastname: Lichtensztajn
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
authors.forename: Weiva
authors.initials: W
authors.lastname: Sieh
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.forename: James D
authors.initials: JD
authors.lastname: Brooks
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D018426:SEER Program; D014481:United States / Q000453:epidemiology