Ductal (endometrioid) adenocarcinoma of the prostate: a clinicopathological study of 16 cases

Abstract

Sixteen cases of ductal (endometrioid) carcinoma of the prostate are presented. The tumour presents in elderly men (age range 65-87 years) with haematuria or obstructive symptoms. Serum prostate specific antigen may be normal or raised. On cytoscopy, there is often an exophytic lesion in the region of the verumontanum. Histologically, two variants are recognized: papillary and cribriform, of which there were eight cases each. Eight cases consisted of pure ductal carcinoma and seven were mixed, containing a variable proportion of micro-acinar carcinoma. The associated micro-acinar carcinoma had a Gleason score of at least 5. One case of carcinosarcoma with a ductal epithelial component was also included. All cases displayed positive immunohistochemical staining for prostate specific antigen and prostatic acid phosphatase and but were negative for the basal cell marker MA903. The tumour responds well to orthodox micro-acinar carcinoma therapy and appears notably sensitive to hormonal manipulation. Follow-up of the mixed group is restricted to a maximum of 3 years. Of the eight pure cases, five patients are still alive with survival periods of 11, 8, 7, 3 and 1 years. Three patients died of intercurrent disease of which one patient survived 12 years, having received no treatment. This tumour, therefore, can be regarded as having a good prognosis.

Gene expression profiles of ductal versus acinar adenocarcinoma of the prostate

“…Similar to acinar adenocarcinomas, almost all ductal adenocarcinomas express prostate-specific antigen and prostate-specific acid phosphatase. [15][16][17]20 Alpha-methylacyl CoA racemase (AMACR) expression has been detected in 58 to 100% of ductal adenocarcinomas. [22][23][24] Although a lower percentage of cases of ductal adenocarcinoma seem to express AMACR compared with acinar adenocarcinoma, it has not been established whether there are comparative quantitative differences in AMACR protein levels.…”

“…Limited scale data do exist on comparative protein expression in ductal versus acinar adenocarcinoma, 7,12,[14][15][16][17][18][19][20][21][22][23][24][25] but comparative global gene expression profiling has not been performed. The aim of this study was to examine the gene expression profiles of ductal versus acinar adenocarcinoma to assess the molecular relatedness of ductal and acinar adenocarcinomas and to identify potential molecular differences that may explain the different histopathological features and disparate clinical behavior of ductal adenocarcinoma of the prostate.…”

A comprehensive review of incidence and survival in patients with rare histological variants of prostate cancer in the United States from 1973 to 2008

“…Ductal adenocarcinomas of the prostate typically stain positive for PSAP and PSA. 8 The majority of these cancers present with high grade features and a primary Gleason pattern of 4, although patterns of 3 and 5 may also be seen. 9 A retrospective study of 108 patients by Tu et al 10 including patients undergoing radical prostatectomy for ductal adenocarcinoma of the prostate demonstrated that patients with pure ductal adenocarcinoma had shorter time to local recurrence (2.8 vs 4.9 years) but longer median OS (13.8 vs 8.9 years) than patients with mixed ductal adenocarcinomas after surgery.…”

Unusual subtypes of prostate cancer

“…[4][5][6][7][8][9][10][11][12] It can be identified as a lesser pattern in up to 3% of cases. Initially, these tumors were believed to be of endometrial origin arising in the verumontanum, a mü llerian remnant; 4,5 however, it is now recognized that these are of prostatic epithelial origin.…”

“…Initially, these tumors were believed to be of endometrial origin arising in the verumontanum, a mü llerian remnant; 4,5 however, it is now recognized that these are of prostatic epithelial origin. [6][7][8][9][10][11][12] The concept of ductal adenocarcinoma as a specific entity has been challenged, most recently by Bock and Bostwick. 13 In a study utilizing LOH analysis of 12 polymorphic microsatellite markers, frequently lost in prostate cancer, Dawkins et al 14 reported LOH in none of the Gleason grade 3 tumors studied, 9% of high-grade prostatic intraepithelial neoplasia (HGPIN) lesions, 29% of Gleason grade 4 cancers and 60% of ductal adenocarcinomas, suggesting that these are in fact a different lesion.…”