Ductal prostate cancer: Clinical features and outcomes from a multicenter retrospective analysis and overview of the current literature

Abstract

ObjectiveThe aim of the study is to evaluate clinical features and outcomes after different therapeutic strategies for ductal prostate adenocarcinoma (DPC), a rare but aggressive subtype of invasive prostate cancer (PCa) accounting for, in the pure and mixed form, 1% or less and 5% or less, respectively, of all the newly diagnosed PCa.Materials and methodsPatients with a proven diagnosis of DPC undergoing surgery, radiotherapy, and androgen deprivation therapy, alone or in combination, were considered for this multicenter, retrospective study. The study assessed overall survival (OS), disease-free survival (DFS), and age-related disease-specific survival.ResultsEighty-one patients met the study inclusion criteria. Pure DPC was found in 29 patients (36%) and mixed ductal-acinar-PCa in 52 patients (64%). After a median follow-up of 63 months (range, 3–206 months), 3- and 5-year OS rates were 84% and 67%, respectively, and 3- and 5-year DFS rates were 54% and 34%, respectively. There were no significant differences in OS or DFS between the pure and mixed DPC groups. Pure DPC was associated with a higher rate of metastatic disease at onset. Patients 74 years or younger had better disease-specific survival (p=0.0019). A subgroup analysis favored radiotherapy as the primary treatment for nonmetastatic, organ-confined DPC (3- and 5-year DFS of 80% and 50%, respectively, compared with 5-year DFS of 35% for surgical patients; p = 0.023).ConclusionsOur study found DPC to be rarer, more aggressive, more likely to metastasize, and have a worse prognosis than the common acinar variant, especially in its pure form. Multicenter series are encouraged to obtain large data sets, or propensity score matching analyses with patients with conventional PCa are desirable to understand the best therapeutic approach and improve outcomes.

Construction and validation of a prognostic nomogram for ductal adenocarcinoma of the prostate: A population-based study

“…[ 17 ] Because DAC often originates from the prostatic ducts around the primary urethra, most patients are found in the clinic with urinary obstruction or hematuria. [ 18 ] There is evidence that DAC has a lower PSA value at the time of diagnosis compared to APC and is therefore diagnosed at a more advanced stage. [ 19 ] Our study also confirmed this, with the majority of patients having a PSA < 10 ng/mL.…”

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

“…Radiotherapy plays a crucial role in the management of PCa, both with curative intent and in the salvage setting. Emerging data have placed RT as a useful therapeutic option also for oligometastatic and oligorecurrent/oligoprogressive disease (22), rare histologies (23)(24)(25), or in combination with new drugs available for hormone-sensitive and castrateresistant PCa.…”

Prognostic factors and construction of a nomogram prediction model for ductal adenocarcinoma of the prostate based on the SEER database

“…DAC with other Pca subtypes is more common than pure DAC [20]. As DAC often originates from the prostatic ducts around the primary urethra, most patients are found in the clinic with urinary obstruction or haematuria [21]. There is evidence that DAC has a lower PSA value at the time of diagnosis compared to APC and is therefore diagnosed at a more advanced stage [22].…”