Ductal Adenocarcinoma Of The Prostate: Clinical Features And Implications After Local Therapy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 12 Jul 2009 - 0:00 PDT


UroToday.com - On occasion, urologists will encounter subtypes of prostate cancer (CaP) other than adenocarcinoma. One such subtype is ductal (or endometrioid) CaP. Ductal CaP is characterized by the presence of tall, pseudostratified columnar cells with abundant cytoplasm arranged in a papillary pattern. It can be diagnosed with high Gleason score and advanced stage, but its clinical course has been relatively undefined. In the online version of Cancer, Dr. Shi-Ming Tu and colleagues report a series of 108 patients with ductal CaP.

Clinical and pathological variables were retrospectively assessed in these 76 patients who had undergone radical prostatectomy (RP) or the other 32 non-surgical patients who had primarily received radiotherapy. Seventy-five surgical patients were evaluable with a median follow-up of 4.9 years. Interestingly 79% of the men who received a diagnosis of ductal CaP were found to have this subtype in the RP specimen, as opposed to detection on the initial prostate biopsy. Ten men had pure ductal subtype, 15 men had predominately ductal subtype and the other 50 patients had mixed ductal and acinar CaP. PSA, age, stage and Gleason score did not differ between the pure and mixed pathology groups.

The median overall survival was 13.8 years for the pure histological group and 8.9 years for the mixed group. The median time to local progression was 2.8 years vs. 4.9 years and the median time to distant metastasis was 3.9 years vs. 2.0 years for patients who had pure ductal CaP vs. mixed ductal CaP of the prostate after RP, respectively. The majority of the non-surgical group was diagnosed by TURP and the median delivered radiotherapy dose was 70 Gy. Median overall survival for the non-surgical group was 8.2 years. The authors conclude that the increased local progression rate in the pure ductal CaP group supports a role for RP as the best option for local control.

Tu SM, Lopez A, Leibovici D, Bilen MA, Evliyaoglu F, Aparicio A, Guo CC, Kuban DA, Johnson MM, Pisters LL
Cancer. 2009 Apr 28. Epub ahead of print.
doi:10.1002/cncr.24326

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2009 - UroToday

• Additional
• References
• Citations