The presence of intraductal carcinoma of the prostate in needle biopsy is a significant prognostic factor for prostate cancer patients with distant metastasis at initial presentation

Abstract

Intraductal carcinoma of the prostate is an adverse prognostic factor in localized prostate cancer patients. However, whether it influences outcome of those patients with distant metastases discovered at initial diagnosis is unclear. Here, we evaluated whether the presence of intraductal carcinoma of the prostate in prostate needle biopsies is an adverse prognostic factor for cancer-specific survival and overall survival in such prostate cancer patients. We retrospectively enrolled 150 eligible patients. All patients received androgen-deprivation therapy and/or chemotherapy. Their age, performance status, pain, metastatic sites, clinical T stage, serum prostatespecific antigen, alkaline phosphatase, hemoglobin, Gleason score, and the presence of Gleason pattern 5 were analyzed. Primary end point was cancer-specific survival; secondary end points included prostate-specific antigen progression-free survival and overall survival. Fine and Gray's model and the Cox proportional hazards model were used as statistical tests. Intraductal carcinoma of the prostate was detected in 100 (67%) patients. At a median follow-up of 38 months, 79 patients (53%) had died of the disease and nine (6%) had died of other causes. The average time interval to cancer-related death was 28 months. On multivariate analysis, only intraductal carcinoma of the prostate was significantly associated with cancer-specific survival (P = 0.018) and overall survival (P = 0.001), and only the presence of Gleason pattern 5 was significantly associated with prostate-specific antigen progression-free survival (P = 0.026). The presence of intraductal carcinoma of the prostate was the only significant prognostic parameter for cancer-specific survival and overall survival in prostate cancer patients with distant metastasis at presentation. These results may prove useful in planning future treatments.

Prognostic parameter for high risk prostate cancer patients at initial presentation

“…Both of them did not demonstrated the presence of IDC‐P and was a prognostic factor by multivariate analysis, although they showed it was a prognostic factor by univariate analysis. Our previous study showed that the incidence of IDC‐P was 36.3% in the needle biopsy of patients with high‐risk prostate cancer and 50.5% in radical prostatectomy specimens from high‐risk patients, while the incidence was 66.7% in patients with prostate cancer and a distant metastasis . Later, Porter et al reported IDC‐P frequencies in a large database of 23.1, 36.7, and 56.0% in the intermediate‐risk, high‐risk, and metastatic or recurrent disease risk categories, respectively; this result is almost the same as in our previous study.…”

“…We previously reported for the first time that the presence of IDC‐P in radical prostatectomy specimens is the only prognostic factor for high‐risk prostate cancer in terms of PFS and CSS. IDC‐P in needle biopsies could also become an adverse prognostic factor for PSA‐PFS, CSS, and OS in patients with prostate cancer and a distant metastasis at the initial diagnosis . A Chinese group and a Norwegian group also recently discussed the relationship between presence of IDC‐P on diagnostic needle biopsy and a high risk of mortality in localized and metastatic prostate cancer patients .…”

“…IDC‐P was defined according to the criteria of McNeal . Details on the definition of IDC‐P were described previously …”

The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance

“…The resulting common understanding, besides the recognition of IDC‐P, is the strong association of IDC‐P with high‐grade and high‐volume invasive prostate cancer (PCa). Previous studies have associated IDC‐P with a poor prognosis and shorter biochemical‐recurrence‐free survival . Our group reported that IDC‐P is an adverse prognostic factor for patients with high‐risk or metastatic PCa patients .…”

“…Van der Kwast et al recommended the presence of IDC‐P in a needle biopsy as a predictive factor for patients with intermediate‐ and high‐risk PCa treated by radiotherapy. Moreover, we previously reported that the presence of IDC‐P was the only prognostic factor for the progression free survival, cancer‐specific survival, and overall survival; those results were obtained from a multivariate analysis of patients who underwent radical prostatectomy and had distant metastasis at their initial presentation . As these studies make clear, IDC‐P correlates with increased stage and prognosis .…”