Ductal Adenocarcinoma of the Prostate: Increased Mortality Risk and Decreased Serum Prostate Specific Antigen

Abstract

Introduction and Objectives The clinical significance of ductal prostatic carcinoma has not been well defined. We utilized a population-based cancer registry to identify a large group of ductal carcinoma cases to characterize the impact of the ductal subtype on the presentation and survival of men with prostate cancer. Methods A national cancer registry was used to identify incident cases of ductal and acinar adenocarcinomas from 1996–2006. Clinicopathologic variables were analyzed and Cox multivariate survival analysis performed. PSA values were available for the years 2004–2006, and these were used to assess for differences in Gleason grade and serum PSA levels between ductal and acinar cancers at the time of diagnosis. Results A total of 442,881 acinar cases and 371 ductal cases were identified. Ductal cases were more likely to present with distant disease (12% vs. 4%, p<0.001) and to be poorly differentiated (50% vs. 32%; p<0.001). Ductal histology was associated with a 30% lowering of the geometric mean PSA (adjusted coeff.=0.7, 95% CI 0.6–0.8) and a more than two-fold increased odds of having a PSA<4.0 ng/ml (OR 2.4, 95% CI 1.4–4.0) independent of other clinicopathologic variables. For those with non-distant disease at diagnosis, ductal histology was associated with a 2.4-fold (CI 1.5–3.8) increased disease-specific mortality. Conclusions In the largest series of this histologic subtype, ductal cancers were more likely to present with advanced stage cancer and a lower PSA, suggesting that timely detection of the disease is a significant challenge. In addition, those with loco regional disease were more likely to die of their disease.

Advanced prostatic ductal carcinoma in a patient with a long survival time following a total pelvis exenteration: A case report

“…Although the clinical course of DAP remains controversial, the majority of studies indicate that the variant of PCa exhibits more aggressive biological behavior, a more advanced stage, a worse 5-year survival rate and a shorter time to progression compared with conventional acinar carcinoma (4,6).…”

“…However, subsequent studies have clearly confirmed the prostatic origin of DAP, which is supported by a favorable response to orchiectomy, the expression of prostatic-specific antigen (PSA) and ultrastructural findings (3). DAP is a rare subtype of prostate cancer (PCa) that has a poorly-understood etiology, and more commonly occurs in Caucasian males that are >70 years of age (4). A previous study that reviewed the histological slides of 2,600 prostatic carcinomas reported a prevalence of 0.4-0.8% for pure ductal adenocarcinoma and 5% for mixed ductal adenocarcinoma (5).…”

Chemotherapy with Gemcitabine and Cisplatin for Advanced Ductal Adenocarcinoma of the Prostate: Clinical Courses of Two Patients

“…It is a unique subtype of prostate cancer characterized by the presence of tall, pseudo-stratified, columnar cells with abundant cytoplasm arranged in a papillary pattern (Morgan et al 2010). Serum prostate-specific antigen (PSA) levels are often lower than those of conventional acinar prostate cancer (acinar PCa), and it is often diagnosed at an advanced stage.…”

Prostatic ductal adenocarcinoma: An aggressive variant that is underdiagnosed and undersampled on transrectal ultrasound (TRUS)-guided needle biopsy

“…Ductal adenocarcinoma secretes less prostatic serum antigen (PSA) than acinar adenocarcinoma and it can appear occult on some magnetic resonance imaging (MRI) sequences. 7,8 Most ductal adenocarcinomas arise in the peripheral zone and extend toward the urethral lumen, although occasionally ductal cancer arises in the transition zone exclusively. 3,9 This creates a diagnostic challenge as many ductal cancers present with a normal digital rectal examination and are not detected on routine template TRUSguided biopsy.…”