Does ductal adenocarcinoma of the prostate (DA) have any prognostic impact on patients with de novo metastatic prostate cancer?

Abstract

Background: The prognostic value of ductal adenocarcinoma of the prostate (DA) in nonmetastatic prostate cancer (PCa) has been identified in many studies. However, it remains unknown whether DA is an adverse prognostic factor in metastatic PCa (mPCa). Method: Data from 634 mPCa patients histopathologically documented with DA or/and acinar adenocarcinoma of the prostate in our center between 2012 and 2018 were retrospectively analyzed. Propensity score matching (PSM) was used to balance the baseline features. Data from the Surveillance, Epidemiology, and End Results (SEER) database were utilized to validate our findings. Castration‐resistant PCa‐free survival (CFS), overall survival (OS), and cancer‐specific survival (CSS) were set as endpoints. Results: DA was confirmed in 35 of 634 (5.5%) patients. Among the DA‐positive patients, 7 of 35 (20%) and 28 of 35 (80%) harbored high (DA ≥ 50%) and low (DA < 50%) DA components, respectively. DA was not associated with poorer median CFS (mCFS) or median OS (mOS) either before PSM (mCFS: 16.9 vs 18.4 month, P = .814; mOS: 42.0 vs 70.1 month, P = .796) or after PSM (mCFS: 16.9 vs 16.9 month, P = .949; mOS: 42.0 vs 79.9 month, P = .960). Likewise, in the SEER data, DA‐positive patients (n = 15 153) shared similar median CSS (25.0 vs 28.0 month, P = .206) and OS (26.0 vs 35.0 month, P = .095) with DA‐negative patients (n = 70). No prognostic difference was found between patients with high and low DA components. Conclusion: We conducted the first study investigating the prognostic value of DA in de novo mPCa. DA was not associated with adverse clinical outcomes in mPCa patients. These findings are helpful for prognostic evaluation, treatment decision making and counseling in mPCa patients.

Ductal adenocarcinoma of the prostate: A systematic review and meta‐analysis of incidence, presentation, prognosis, and management

“…Interestingly for those patients with metastasis at presentation DAC does not portend worse survival. Wu et al conducted the first study investigating the prognostic value of DAC in de novo metastatic prostate cancer 35 . In their cohort of 634 metastatic prostate cancer cases, the 35 DAC cases were not associated with worse overall or cancer‐specific survival.…”

Prostatic ductal adenocarcinoma variant predicts worse pathological and oncological outcomes: Insight from over 1000 consecutive patients from a large prospective uro‐oncology registry

“…PDA exists in two forms with varying incidence—pure PDA with an incidence of 0.4%–0.8% and mixed ductal adenocarcinoma with an incidence of up to 5% 3 . Though PDA may be found more centrally around the verumontanum or periurethral location (hence may present with early symptoms such as haematuria, urinary obstruction or retention), recent studies seem to suggest that peripheral PDA is still the most common location 2,7 …”

“…Conflicting evidence exists regarding the aggressiveness and prognostic implications of PDA. Older studies supported aggressive biology with PDA, 2,4,5,8–10 associated with multiple adverse pathological outcomes 7,8,11 . In fact, it is typically assigned a Gleason score of 8 or 9 (if comedonecrosis is present), corresponding to the grade group (GG) 4 or 5 12 .…”

“…3 Though PDA may be found more centrally around the verumontanum or periurethral location (hence may present with early symptoms such as haematuria, urinary obstruction or retention), recent studies seem to suggest that peripheral PDA is still the most common location. 2,7 Conflicting evidence exists regarding the aggressiveness and prognostic implications of PDA. Older studies supported aggressive biology with PDA, 2,4,5,[8][9][10] associated with multiple adverse pathological outcomes.…”

“…Older studies supported aggressive biology with PDA, 2,4,5,[8][9][10] associated with multiple adverse pathological outcomes. 7,8,11 In fact, it is typically assigned a Gleason score of 8 or 9…”