Periurethral prostatic duct carcinoma: clinical features and treatment results

FDG PET/CT in a Case of Pure Ductal Adenocarcinoma of the Prostate With Osteolytic Metastases and Normal PSA Level

ABSTRACT

Prostatic ductal adenocarcinoma is an uncommon aggressive subtype of prostate carcinoma. It is more likely to present with advanced stage and lower prostate-specific antigen. We describe FDG PET/CT findings in a case of pure prostatic ductal adenocarcinoma with lymph node, bone and lung metastases, normal serum prostate-specific antigen level, and elevated serum carbohydrate antigen 19-9 and carbohydrate antigen 724 levels. The primary tumor, and lymph node and bone metastases were hypermetabolic. All the bone metastases were osteolytic. The multiple lung metastases showed no significant FDG uptake, which may be due to small size.

Prevalence of prostate cancer in men with haematuria: a systematic review and meta-analysis

OBJECTIVES

To investigate the prevalence of prostate cancer in men attending evaluation for haematuria, as this could help healthcare providers to determine whether men with haematuria should have prostate examinations performed.

METHODS

The study was performed according to a pre-specified protocol uploaded to the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022299383). A systematic search of MEDLINE, Ovid and Google Scholar was performed in December 2021. Two independent researchers evaluated all titles, available abstracts, and full texts. We included studies on adult men (aged ≥18 years) describing haematuria and prostate cancer.

RESULTS

We screened 4252 titles and abstracts when available and assessed 350 studies in full text. In total, 65 studies were included and 42 was summarised in a meta-analysis. In total, 18 752 men with haematuria were included, and the pooled prevalence (95% confidence interval [CI]) of prostate cancer was 3.0% (2.0-4.1%). In men with macroscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 5.9% (2.9-9.9%; n = 265/5373). In men with microscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 1.4% (0.8-2.2%; n = 71/6642).

CONCLUSION

Our findings indicate that the prevalence of prostate cancer is considerable in men attending evaluation for haematuria. Therefore, digital rectal examination and prostate-specific antigen measurement should become a standard procedure for all men with haematuria, especially for men with macroscopic haematuria.

The update of prostatic ductal adenocarcinoma

Since initially described in 1967, prostatic ductal adenocarcinoma (PDA) has engendered a series of controversies on its origin, histological features, and biological behavior. Owing to the improvement of molecular biological technique, there are some updated findings on the characteristics of PDA. In the current review, we will mainly analyze its origin, clinical manifestations, morphological features, differential diagnosis, immunophenotype and molecular genetics, with the purpose of enhancing recognition of this tumor and making a correct diagnosis and treatment choice.

Immunohistochemical characterization of canine prostatic carcinoma and correlation with castration status and castration time

The purpose of this study was to characterize canine prostate cancer using immunohistochemical staining specific for acinar and urothelial/ductal tissue and correlate these results with the dogs' castration status/castration time. Seventy dogs with prostate cancer were included, 71% were castrated and 29% were intact. Compared with an age-matched control population, castrated dogs were at increased risk of prostate cancer, odds ratio 3.9. Immunohistochemical staining was performed on 58 cases. Forty-six of the 58 stained positive for cytokeratin 7 (CK 7) (ductal/urothelial origin) and one of the 58 stained positive for prostate-specific antigen. Dogs with CK 7-positive tumours were younger when castrated than dogs with CK 7-negative tumours, 2 versus 7 years (P = 0.03); dogs castrated at <or=2 years of age were more likely to be CK 7-positive (P = 0.009). These results show that most canine prostatic carcinomas are of ductal/urothelial, androgen-independent origin. This is consistent with the epidemiological findings, showing increased risk in castrated dogs. Canine prostate cancer may, therefore, not be a realistic model for the human disease.

Carcinoma transicional primario puro de próstata. revisión de nuestra serie

Primary prostate transitional cell carcinoma is a very uncommon tumor, that represents about 1% of all prostate tumours. In our institution, only six patients have been diagnosed with pure transitional cell prostate carcinoma until 2002. Bladder origin of the neplasic was ruled out in all cases. We report a study about the progression and survival of prostate transitional cell carcinoma. These prostatic tumours carry a poor prognostic (median survival is 4.6 months) with a strong tendency to metastatic spread. Therefore, we suggest a radical prostatectomy (without cystectomy) when it rules out bladder origin tumour.

[Primary transitional carcinoma of the prostatic ductus]

Primary prostate transitional cell carcinoma is a very rare tumour originating in the transitional epithelial cells of the intraprostate periurethral ductus. Only 17 of 829 patients diagnosed with prostate carcinoma were found to have the transitional cell variety. Eight (8) of those had pure transitional cell carcinoma and 9 a mixed presentation of acinar adenocarcinoma and transitional cell ductal carcinoma. Bladder origin of the tumour was ruled out in all cases. We report a retrospective study on the clinical behaviour of prostate transitional cell carcinoma. Compared to acinar carcinomas, few differences were found when age, symptoms, physical findings and imaging diagnosis were evaluated. Clinical presentation, DRE, PSA, metastatic spread and presence of supravesical obstructive uropathy where also studied to establish a diagnosis. Radiotherapy was the most frequently used therapeutical approach. Mean survival is 26.6 months (4-60 months) and there has been 11 death up to now. Compared to acinar forms, this tumour shows a hormone-resistant, aggressive biological behaviour with poor prognosis. Early diagnosis and radical surgery are the only options available to increase life expectancy for these patients.

[Transitional carcinoma of the prostate]

Case report of prostate transitional carcinoma diagnosed by transurethral resection, an infrequent tumour with incidence ranging from 1% to 4% of all prostate neoplasias which appears in 2.8% of all radical cystoprostatectomies specimens carried out at the Mayo Clinic. Most commonly, when it appears in the prostate this tumour is simultaneous or subsequent to other transitional carcinoma arisen in other organs mostly the bladder. Very rarely it occurs as an early form within the ducts and even less often within the prostate acinus. Review of the neoplasia histology, signs and symptoms, diagnostic procedures and management, emphasising the aggressiveness of its behaviour (such as in our case report) when the prostate gland stroma is infiltrated by the tumour.

Transitional cell carcinoma of the prostate in patients undergoing radical cystoprostatectomy

To assess the impact of prostatic involvement with transitional cell carcinoma we reviewed the clinical outcome of 49 patients with transitional cell carcinoma of the prostate. In addition, 115 step-sectioned cystoprostatectomy specimens removed for bladder transitional cell carcinoma were studied to determine the true incidence of secondary prostatic involvement by transitional cell carcinoma. Specimens from 300 prostates removed for prostatic adenocarcinoma also were reviewed to investigate the presence of incidental transitional cell carcinoma arising within the prostate. Transitional cell carcinoma was found in 29% of the step-sectioned specimens and in none of the radical prostatectomy specimens. The presence of prostatic invasion either into the stroma or involving prostatic ducts and acini only had no adverse effect on outcome. Lymph node status and bladder stage, and not prostatic invasion were the determining factors of survival. The presence of seminal vesicle involvement or prostatic stromal invasion appeared to predict for lymph node involvement. With a mean followup of more than 3 years 75% of our patients who had negative lymph nodes and low stage bladder lesions are alive without evidence of disease. In our series prostatic involvement by transitional cell carcinoma did not impact on survival when patients were treated aggressively with radical cystoprostatectomy.

Histopathological pattern in prostatic adenocarcinomas: is it a prognostic criterion?

A total of 152 patients with prostatic carcinoma were evaluated retrospectively. Sections prepared from paraffin blocks were examined and all cases were scored according to the Gleason grading system. Prostatic adenocarcinomas were categorized into 3 different groups of histopathological patterns; acinar, ductal and mixed. The relationships between histopathologic pattern and symptoms, clinical findings, clinical stage, Gleason scores and local or systemic progression were investigated. It was found that patients with mixed pattern tumours presenting at later stages with more severe symptoms of prostatism had higher Gleason scores and higher progression rates compared to patients with tumours having acinar pattern.

Primary transitional cell carcinoma of prostate: case with lymph node metastasis eradicated by neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) therapy

A case of transitional cell carcinoma of the periurethral prostatic ducts received neoadjuvant chemotherapy consisting of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC), which eradicated pelvic lymph node metastasis, followed by cystoprostatectomy. M-VAC therapy may be indicated for metastatic transitional cell carcinoma of the periurethral prostatic ducts.

Pathologic aspects of prostate cancer: prediction of malignant potential

Despite our expanding knowledge of prostatic histopathology, several controversies regarding the prediction of a tumor's biologic behavior still exist. Numerous histologic grading schemes specific for prostate carcinomas have been developed, but pathologists and urologists do not agree on which system is most accurate. Unfortunately, the Broders system, which is frequently used, tends to underestimate tumor grade and malignant potential. Recently, computer-assisted nuclear morphometry has added objectivity to the formerly subjective grading process, and improved prognostic accuracy for early and advanced disease. The relationship between tumor volume and grade remains controversial. Although it has been stated that volume and grade are directly related, our examination of radical prostatectomy specimens casts some doubt on this. While it can be shown that tumor volume is proportional to the surface area of capsular penetration by malignant cells, tumor penetration is more closely related to histologic grade.

Evaluation of prostatic cancer histology and grade distribution: experience with the Colorado Central Cancer Registry

Although well-defined grading schemes for prostatic adenocarcinoma have been developed, they are not yet universally accepted by practicing surgical pathologists. The complexity of these schemes often leads surgical pathologists to develop their own modified Broders scheme. This study compared the grade distribution as obtained by a community of surgical pathologists with that obtained using the National Prostatic Cancer Project (NPCP) and Gleason grading schemes. In 1978, 308 cases of prostate cancer were reported to the Colorado Central Cancer Registry (CCCR) from the Denver Standard Metropolitan Statistical Area. Two hundred eighteen of these cases were regraded. The grade distribution as reported by the CCCR revealed a predominance of low-grade tumors (grade I-41%, grade II-28%, grade III-17%, grade IV-3%). Regrading of these same cases revealed a shift to higher grades (NPCP: grade I-14%, grade II-11%, grade III-37%, grade IV-29%; Gleason: pattern scores less than 6-30%, score 6-24%, score 7-12%, score 8-11%, score 9-10%, score 10-4%). Twenty-one cases of histologic variants which were not originally diagnosed were also noted (six mucinous, 12 ductal, two endometroioid, one squamous). There were 18 cases in which no evidence of carcinoma was confirmed. These results suggest that there is a tendency to underestimate grade and potentially malignant behavior when well-defined prostatic cancer grading schemes are not applied.

Primary transitional cell carcinoma of prostatic periurethral ducts

Primary transitional cell carcinoma of the prostatic periurethral ducts is a distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.

Carcinoma of the prostate of ductal origin

Thirty-nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate-specific antigen in all ductal carcinomas.

Transitional cell carcinoma involving the prostate

Transitional cell carcinoma involving the prostate gland was studied in 27 patients. Three different groups were recognised on the basis of the clinical pattern and histological findings. Each group has a different prognosis and merits a different approach to treatment. Thus, stromal involvement of the prostate by transitional cell carcinoma is a sinister finding that requires radical treatment, whereas ductal involvement by either carcinoma in situ or non-invasive papillary tumours can be managed less aggressively. This study emphasises that the present classification for these tumours is unsatisfactory and that adequate histopathological information is essential for their management.

A new prostatic cancer model: systemic induction of prostatic cancer in rats by a nitrosamine

Weekly intragastric application of N-nitrosobis(2-oxopropyl) amine (BOP) at a dose of 10 mg/kg body wt induced prostatic cancer in 5 out of 15 MRC rats. Hyperplasia and metaplasia of the prostatic gland were found in 13 rats with or without cancer. All tumors had developed in the dorsal lobe, had reached a size of up to 20 mm and were invasive. Distant metastases were not observed. Although hyperplastic lesion were of a glandular type, all carcinomas had squamous cell character. All cases of prostatic cancer were associated with papillomas or carcinomas of the urethral epithelium, which had initially developed in the colliculus seminalis. The induction of prostatic cancer for the first time by a systemic application by a nitrosamine provides a promising model for understanding basic principals of prostatic cancer.

The management of transitional cell carcinoma in the prostate

Transitional cell carcinoma of the prostate is a rare tumour. A review of 318 patients with carcinoma of the prostate presenting to this hospital in the 5 years between April 1974 and April 1979 revealed 7 patients with transitional cell carcinoma arising within the prostate. Two of these had previously been treated for a transitional cell carcinoma of the bladder. These prostatic tumours are usually poorly differentiated and carry a poor prognosis. Early radical surgery, however, achieved a good result in one of our patients. Other forms of treatment were ineffective and a review of the literature revealed that this was also the experience of others. We suggest that cystoprostatectomy should be considered as an early form of treatment.