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Shi Y, Wang H, Golijanin B, Amin A, Lee J, Sikov M, Hyams E, Pareek G, Carneiro BA, Mega AE, Lagos GG, Wang L, Wang Z, Cheng L. Ductal, intraductal, and cribriform carcinoma of the prostate: Molecular characteristics and clinical management. Urol Oncol 2024; 42:144-154. [PMID: 38485644 DOI: 10.1016/j.urolonc.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 04/15/2024]
Abstract
Prostatic acinar adenocarcinoma accounts for approximately 95% of prostate cancer (CaP) cases. The remaining 5% of histologic subtypes of CaP are known to be more aggressive and have recently garnered substantial attention. These histologic subtypes - namely, prostatic ductal adenocarcinoma (PDA), intraductal carcinoma of the prostate (IDC-P), and cribriform carcinoma of the prostate (CC-P) - typically exhibit distinct growth characteristics, genomic features, and unique oncologic outcomes. For example, PTEN mutations, which cause uncontrolled cell growth, are frequently present in IDC-P and CC-P. Germline mutations in homologous DNA recombination repair (HRR) genes (e.g., BRCA1, BRCA2, ATM, PALB2, and CHEK2) are discovered in 40% of patients with IDC-P, while only 9% of patients without ductal involvement had a germline mutation. CC-P is associated with deletions in common tumor suppressor genes, including PTEN, TP53, NKX3-1, MAP3K7, RB1, and CHD1. Evidence suggests abiraterone may be superior to docetaxel as a first-line treatment for patients with IDC-P. To address these and other critical pathological attributes, this review examines the molecular pathology, genetics, treatments, and oncologic outcomes associated with CC-P, PDA, and IDC-P with the objective of creating a comprehensive resource with a centralized repository of information on PDA, IDC-P, and CC-P.
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Affiliation(s)
- Yibo Shi
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Hanzhang Wang
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT
| | - Borivoj Golijanin
- Department of Surgery (Urology), Warren Alpert Medical School of Brown University, Minimally Invasive Urology Institute, Providence, RI, USA
| | - Ali Amin
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, Lifespan Health, and the Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Joanne Lee
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, Lifespan Health, and the Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Mark Sikov
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence RI
| | - Elias Hyams
- Department of Surgery (Urology), Warren Alpert Medical School of Brown University, Minimally Invasive Urology Institute, Providence, RI, USA
| | - Gyan Pareek
- Department of Surgery (Urology), Warren Alpert Medical School of Brown University, Minimally Invasive Urology Institute, Providence, RI, USA
| | - Benedito A Carneiro
- Division of Hematology and Oncology, The Legorreta Cancer Center at Brown University, Lifespan Cancer Institute, Providence, RI
| | - Anthony E Mega
- Division of Hematology and Oncology, The Legorreta Cancer Center at Brown University, Lifespan Cancer Institute, Providence, RI
| | - Galina G Lagos
- Division of Hematology and Oncology, The Legorreta Cancer Center at Brown University, Lifespan Cancer Institute, Providence, RI
| | - Lisha Wang
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Zhiping Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, Lifespan Health, and the Legorreta Cancer Center at Brown University, Providence, RI, USA.
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Li C, Wan Z, Wang Y, Shan G, Yang B. Construction and validation of a prognostic nomogram for ductal adenocarcinoma of the prostate: A population-based study. Medicine (Baltimore) 2024; 103:e36877. [PMID: 38215130 PMCID: PMC10783338 DOI: 10.1097/md.0000000000036877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
This study aimed to establish and validate a nomogram for ductal adenocarcinoma of the prostate (DAC) to accurately predict the prognosis of DAC patients. The data of 834 patients with confirmed DAC were obtained from the Surveillance, Epidemiology, and End Results database. The cases were randomly assigned to the training and internal validation cohorts. Data from patients attending our institution as an external validation cohort (n = 35). Nomogram and web-based dynamic nomogram were constructed based on Cox regression analysis, and their prediction accuracy was evaluated by concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis. Multivariate analyses identified age, T-stage, N-stage, M-stage, surgery, lymph node dissection, Gleason score, and PSA as independent prognostic factors for overall survival. The C-index and calibration curves demonstrate the good discriminative performance of the prediction model. The area under the curve further confirmed the accuracy of the nomogram in predicting survival. In addition, the area under the curve and decision curve analysis were better than the 7th tumor-node-metastasis staging system. The Kaplan-Meier curves of the nomogram-based risk groups showed significant differences (P < .001). We constructed and validated the first nomogram to predict patients with DAC.
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Affiliation(s)
- Cheng Li
- The Second Clinical Medical College of Binzhou Medical University, Yantai, Shandong, China
| | - Zhengqiang Wan
- The Second Clinical Medical College of Binzhou Medical University, Yantai, Shandong, China
| | - Yinglei Wang
- The Second Ward of Urology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Guangming Shan
- The Second Ward of Urology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Baoquan Yang
- The Second Clinical Medical College of Binzhou Medical University, Yantai, Shandong, China
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Dong A, Lin X, Bai Y, Yang B, Xu S. FDG PET/CT in a Case of Pure Ductal Adenocarcinoma of the Prostate With Osteolytic Metastases and Normal PSA Level. Clin Nucl Med 2023; 48:640-642. [PMID: 36976639 DOI: 10.1097/rlu.0000000000004643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Bo Yang
- Urology, The First Affiliated Hospital of Naval Medical University
| | - Shengming Xu
- Department of Orthopaedic Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kwok JK, Martell K, Sia M, Bhindi B, Abedin T, Lu S, Quon HC. Local Prostate Radiation Therapy and Symptomatic Local Events in De Novo Metastatic Prostate Cancer. Pract Radiat Oncol 2023; 13:e61-e67. [PMID: 36064183 DOI: 10.1016/j.prro.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Local prostate radiation therapy (LPRT) for low-burden metastatic prostate cancer (mPCa) improves overall survival and is the standard of care. The role of LPRT in reducing symptomatic local events (SLE) remains unclear. We aimed to identify SLE risk factors and to evaluate the association between LPRT and SLE in mPCa. METHODS AND MATERIALS We conducted a retrospective, population-based cohort study of patients initially diagnosed with mPCa between 2005 and 2016 in a cancer registry. Patient, tumor, and treatment characteristics were obtained from chart review and the cancer registry. The coprimary endpoints were genitourinary (GU) and gastrointestinal (GI) SLE, identified by physician billing claims between 2004 and 2017 for diagnostic or therapeutic procedures potentially related to GU and GI SLE. The effect of LPRT on SLE was evaluated using both recurrent event (Andersen-Gill model) and time-to-first-event sequential landmark analyses. Risk factors for SLE were assessed by multivariable Cox regression. LPRT was defined as ≥40 Gy within 1 year of diagnosis. Metastatic burden was defined per the STAMPEDE trial. RESULTS Of 1363 patients, 46 (3.4%) received LPRT. Median follow-up was 27.3 and 28.9 months in the control and LPRT groups, respectively. LPRT was associated with less recurrent GU SLE (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.17-0.67; P = .002), upper tract obstruction (HR, 0.20; 95% CI, 0.05-0.84; P = .03), and cystoscopy (HR, 0.38; 95% CI, 0.15-0.96; P = .04). Metastatic burden was not associated with SLE. CONCLUSIONS LPRT in mPCa was associated with less recurrent GU SLE, specifically for upper tract obstruction and cystoscopy.
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Affiliation(s)
- Jaime Kirsten Kwok
- Tom Baker Cancer Centre, Calgary, Alberta, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Martell
- Tom Baker Cancer Centre, Calgary, Alberta, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Sia
- Tom Baker Cancer Centre, Calgary, Alberta, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Bimal Bhindi
- Division of Urology, Department of Surgery, University of Calgary and Southern Alberta Institute of Urology, Calgary, Alberta, Canada
| | | | - Shuang Lu
- Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Harvey Charles Quon
- Tom Baker Cancer Centre, Calgary, Alberta, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
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Wei Y, Kobayashi T, Lu Y, Vogel M, Zhang R, Wu J, Gao Y, Lin L, Zhu Q, Ye L, Horie S, Wang X, Li T. Comparison of Survival Outcomes and Risk Factors Between Ductal Carcinoma of the Prostate and Acinar Adenocarcinoma of the Prostate: A Population-based Propensity Score-matching Study. EUR UROL SUPPL 2022; 46:88-95. [PMID: 36506256 PMCID: PMC9732471 DOI: 10.1016/j.euros.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background Ductal carcinoma of the prostate (DCP) is a rare type of prostate cancer (PCa) with a higher degree of infiltration and worse prognosis than acinar adenocarcinoma of the prostate (ACP). Previous reports comparing DCP and ACP have not been very reliable and involved small sample sizes. Objective To assess differences in mortality between ACP and DCP in a large-scale study. Design setting and participants Data were downloaded from the Surveillance, Epidemiology, and End Results database in June 2022. Data for 823 939 patients diagnosed with PCa from 2004 to 2019 were examined, excluding cases with survival data missing or pathological types other than DCP and ACP. Outcome measurements and statistical analysis Prognostic and risk factors for DCP were analyzed by generating a propensity score-matched cohort of DCP and ACP cases (1:5). Adjusted Cox models were constructed to determine hazard ratios (HRs) with 95% confidence intervals (CIs) for cancer-specific mortality (CSM) and overall mortality (OM). Results and limitations A total of 822 607 cases (99.8%) has ACP and 1332 (0.2%) had DCP. In comparison to ACP, age at diagnosis was significantly lower for DCP (≤66 yr: 38.0% vs 50.7%; p < 0.001) and a higher proportion of DCP patients distant metastases (13.7% vs 5.1%; p < 0.001). In comparison to the ACP group, significantly higher proportions of the DCP group underwent surgery (66.1% vs 38.1%; p < 0.001), radiotherapy (13.7% vs 3.1%; p < 0.001), or systemic therapy (18.2% vs 3.3%; p < 0.001). However, the median overall survival time was significantly shorter for DCP patients (44.0 vs 73.0 mo; p < 0.001). DCP patients also had higher risk of CSM (HR 2.07, 95% CI 1.68-2.56; p < 0.001) and OM (HR 2.73 95% CI 2.42-3.08; p < 0.001) after propensity score matching to adjust for the influence of baseline variables. Subgroup analysis showed that DCP patients who had surgical treatment had better CSM than those without surgery, while DCP patients with regional and lower stage had better OM than those with distant stage (both p < 0.05 for interaction). Conclusions The risk of CSM and OM is significantly higher for DCP than for ACP. Earlier detection (lower stage) and surgical treatment are beneficial factors for DCP prognosis. Patient summary We studied survival rates for two different types of prostate cancer. We found that survival is worse for the rarer ductal carcinoma of the prostate (DCP) than for the more common acinar adenocarcinoma of the prostate. Both early diagnosis when the cancer is at a lower stage and surgical treatment are beneficial for survival in patients with DCP.
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Affiliation(s)
- Yongbao Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Takuro Kobayashi
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yan Lu
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Ruochen Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Jinfeng Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Yunliang Gao
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Le Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Qingguo Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Liefu Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan,Corresponding authors. Department of Urology, Fujian Provincial Hospital, 134 Dongjie Street, Gulou District, Fuzhou 350001, Fujian, China (T. Li). Department of Bioinformatics, School of Medical Technology and Engineering, Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China (X. Wang). Department of Urology, Juntendo University School of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan (S. Horie).
| | - Xianlong Wang
- Department of Bioinformatics, School of Medical Technology and Engineering, Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China,Corresponding authors. Department of Urology, Fujian Provincial Hospital, 134 Dongjie Street, Gulou District, Fuzhou 350001, Fujian, China (T. Li). Department of Bioinformatics, School of Medical Technology and Engineering, Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China (X. Wang). Department of Urology, Juntendo University School of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan (S. Horie).
| | - Tao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Urology, Fujian Provincial Hospital, Fuzhou, China,Corresponding authors. Department of Urology, Fujian Provincial Hospital, 134 Dongjie Street, Gulou District, Fuzhou 350001, Fujian, China (T. Li). Department of Bioinformatics, School of Medical Technology and Engineering, Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China (X. Wang). Department of Urology, Juntendo University School of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan (S. Horie).
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Ranasinghe WKB, Troncoso P, Surasi DS, Ibarra Rovira JJ, Bhosale P, Szklaruk J, Kokorovic A, Wang X, Elsheshtawi M, Zhang M, Aparicio A, Chapin BF, Bathala TK. Defining Diagnostic Criteria for Prostatic Ductal Adenocarcinoma at Multiparametric MRI. Radiology 2022; 303:110-118. [PMID: 35076303 DOI: 10.1148/radiol.204732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Prostatic ductal adenocarcinoma (DAC) is an aggressive histologic variant of prostate cancer that often warrants multimodal therapy and poses a significant diagnostic challenge clinically and at imaging. Purpose To develop multiparametric MRI criteria to define DAC and to assess their diagnostic performance in differentiating DAC from prostatic acinar adenocarcinoma (PAC). Materials and Methods Men with histologically proven DAC who had multiparametric MRI before radical prostatectomy were retrospectively identified from January 2011 through November 2018. MRI features were predefined using a subset of nine DACs and then compared for men with peripheral-zone DACs 1 cm or greater in size and men with matched biopsy-confirmed International Society of Urological Pathology grade group 4-5 PAC, by four independent radiologists blinded to the pathologic diagnosis. Diagnostic performance was determined by consensus read. Patient and tumor characteristics were compared by using the Fisher test, t-tests, and Mann-Whitney U test. Agreement (Cohen κ) and sensitivity analyses were also performed. Results There were 59 men with DAC (median age, 63 years [interquartile range, 56, 67 years]) and 59 men with PAC (median age, 64 years [interquartile range, 59, 69 years]). Predefined MRI features, including intermediate T2 signal, well-defined margin, lobulation, and hypointense rim, were detected in a higher proportion of DACs than PACs (76% [45 of 59] vs 5% [three of 59]; P < .001). On consensus reading, the presence of three or more features demonstrated 76% sensitivity, 94% specificity, 94% positive predictive value [PPV], and 80% negative predictive value [NPV] for all DACs and 100% sensitivity, 95% specificity, 81% PPV, and 100% NPV for pure DACs. The DACs and PACs showed no difference in contrast enhancement (100% vs 100%; P >.99, median T2 signal intensity (254 vs 230; P = .99), or apparent diffusion coefficient (median, 677 10-6 mm2/sec vs 685 10-6 mm2/sec; P = .73). Conclusion The presence of intermediate T2 signal, well-defined margin, lobulation, and/or hypointense rim, together with restricted diffusion and contrast enhancement at multiparametric MRI of the prostate, suggests prostatic ductal adenocarcinoma rather than prostatic acinar adenocarcinoma. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Weranja K B Ranasinghe
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Patricia Troncoso
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Devaki Shilpa Surasi
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Juan José Ibarra Rovira
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Priya Bhosale
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Janio Szklaruk
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Andrea Kokorovic
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Xuemei Wang
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Mohamed Elsheshtawi
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Miao Zhang
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Ana Aparicio
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Brian F Chapin
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
| | - Tharakeswara K Bathala
- From the Department of Urology (W.K.B.R., A.K., M.E., B.F.C.), Department of Pathology (P.T., M.Z.), Division of Diagnostic Imaging (D.S.S., J.J.I.R., P.B., J.S., T.K.B.), Department of Biostatistics (X.W.), and Department of Medical Oncology (A.A.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030
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Hidden clues in prostate cancer - Lessons learned from clinical and pre-clinical approaches on diagnosis and risk stratification. Cancer Lett 2022; 524:182-192. [PMID: 34687792 DOI: 10.1016/j.canlet.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Abstract
The heterogeneity of prostate cancer is evident at clinical, morphological and molecular levels. To aid clinical decision making, a three-tiered system for risk stratification is used to designate low-, intermediate-, and high-risk of disease progression. Intermediate-risk prostate cancers are the most frequently diagnosed, and even with common diagnostic features, can exhibit vastly different clinical progression. Thus, improved risk stratification methods are needed to better predict patient outcomes. Here, we provide an overview of the improvements in diagnosis/prognosis arising from advances in pathology reporting of prostate cancer, which can improve risk stratification, especially for patients with intermediate-risk disease. This review discusses updates to pathology reporting of morphological growth patterns, and proposes the utility of integrating prognostic biomarkers or innovative imaging techniques to enhance clinical decision-making. To complement clinical studies, experimental approaches using patient-derived tumors have highlighted important cellular and morphological features associated with aggressive disease that may impact treatment response. The intersection of urology, pathology and scientific disciplines is required to work towards a common goal of understanding disease pathogenesis, improving the stratification of patients with intermediate-risk disease and subsequently defining optimal treatment strategies using precision-based approaches.
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Kobayashi H, Kosaka T, Mikami S, Kimura T, Hongo H, Kosugi M, Sato Y, Oya M. Vasohibin-1 expression as a biomarker of aggressive nature in ductal adenocarcinoma of the prostate: a retrospective cohort study at two centres in Japan. BMJ Open 2021; 11:e056439. [PMID: 34819292 PMCID: PMC8614138 DOI: 10.1136/bmjopen-2021-056439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Vasohibin-1 (VASH1) is an endogenous angiogenesis regulator expressed in activated vascular endothelial cells. We previously reported that high VASH1 expression is a predictor of progression in acinar adenocarcinoma of the prostate. In this study, we evaluated the characteristics of ductal adenocarcinoma of the prostate by comparing the level of VASH1 expression between ductal and acinar adenocarcinoma specimens. DESIGN AND SETTING A retrospective cohort study at two centres in Japan. PARTICIPANTS Among the 1495 patients who underwent radical prostatectomy or transurethral resection for the past 15 years, a total of 14 patients diagnosed with ductal adenocarcinoma and 20 patients diagnosed with acinar adenocarcinoma with a Gleason score of 4+4 were included. INTERVENTIONS We immunohistochemically examined the CD34 expression as the microvessel density (MVD) and activated endothelial cells as the VASH1 density (vessels per mm2). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the association of MVD and VASH1 density between ductal and acinar adenocarcinoma, and the secondary outcome was their oncological outcomes. RESULTS Nine patients (64.3%) with ductal adenocarcinoma were diagnosed at an advanced clinical stage, and five patients (35.7%) died from cancer during a median follow-up of 56.0 months. The VASH1 densities (mean±SD) in ductal and acinar adenocarcinoma were 45.1±18.5 vs 16.1±21.0 (p<0.001), respectively, while the MVD (mean±SD) in ductal and acinar adenocarcinoma were 65.3±21.9 vs 80.8±60.7 (p=0.666), respectively. The 5-year cancer-specific survival rates for high and low VASH1 expression were 70.0% and 100.0% (p=0.006), respectively. High VASH1 expression and a diagnosis of ductal adenocarcinoma were significant predictors of cancer-specific survival. CONCLUSIONS Ductal adenocarcinoma was more aggressive and had higher VASH1 expression than acinar adenocarcinoma, although MVD was equivalent. These results indicate that VASH1 expression may serve as a novel biomarker for the aggressive nature of ductal adenocarcinoma.
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Affiliation(s)
- Hiroaki Kobayashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Tokuhiro Kimura
- Division of Diagnostic Pathology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hiroshi Hongo
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Michio Kosugi
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Atypical Metastases in the Abdomen and Pelvis From Biochemically Recurrent Prostate Cancer: 11C-Choline PET/CT Imaging With Multimodality Correlation. AJR Am J Roentgenol 2021; 218:141-150. [PMID: 34346785 DOI: 10.2214/ajr.21.26426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PET imaging with targeted radiotracers has become integral for mapping the location and burden of recurrent disease in patients with biochemical recurrence (BCR) of prostate cancer (PCa). PET with 11C-choline is part of the National Comprehensive Cancer Network and European Association of Urology guidelines for evaluation of BCR. With advances in PET technology, increasing use of targeted radiotracers, and improved survival of patients with BCR due to novel therapeutics, atypical sites of metastases are being increasingly encountered, challenging the conventional view that PCa rarely metastasizes beyond bones or lymph nodes. We describe such atypical metastases in the abdomen and pelvis on 11C-choline PET (including in the liver, pancreas, genital tract, urinary tract, peritoneum, and abdominal wall, as well as perineural spread), presenting multimodality imaging features and relevant imaging pitfalls. Given atypical metastases' inconsistent relationship with serum PSA and non-specific presenting symptoms, they are often first detected on imaging. Awareness of their imaging features is important as their detection impacts clinical management, patient counseling, prognosis, and clinical trial eligibility. Such awareness is particularly critical as the role of radiologists in the imaging and management of BCR will continue to increase given the expanding regulatory approvals of other targeted and theranostic radiotracers.
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10
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Ranasinghe W, Shapiro DD, Zhang M, Bathala T, Navone N, Thompson TC, Broom B, Aparicio A, Tu SM, Tang C, Davis JW, Pisters L, Chapin BF. Optimizing the diagnosis and management of ductal prostate cancer. Nat Rev Urol 2021; 18:337-358. [PMID: 33824525 DOI: 10.1038/s41585-021-00447-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Ductal adenocarcinoma (DAC) is the most common variant histological subtype of prostate carcinoma and has an aggressive clinical course. DAC is usually characterized and treated as high-risk prostatic acinar adenocarcinoma (PAC). However, DAC has a different biology to that of acinar disease, which often poses a challenge for both diagnosis and management. DAC can be difficult to identify using conventional diagnostic modalities such as serum PSA levels and multiparametric MRI, and the optimal management for localized DAC is unknown owing to the rarity of the disease. Following definitive therapy for localized disease with radical prostatectomy or radiotherapy, the majority of DACs recur with visceral metastases at low PSA levels. Various systemic therapies that have been shown to be effective in high-risk PAC have limited use in treating DAC. Although current understanding of the biology of DAC is limited, genomic analyses have provided insights into the pathology behind its aggressive behaviour and potential future therapeutic targets.
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Affiliation(s)
- Weranja Ranasinghe
- Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Daniel D Shapiro
- Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Miao Zhang
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Tharakeswara Bathala
- Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Nora Navone
- Department of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy C Thompson
- Department of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Bradley Broom
- Department of Bioinformatics and Computational Biology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Chad Tang
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Louis Pisters
- Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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11
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Zheng Z, Qiu K, Huang W. Long Non-Coding RNA (lncRNA) RAMS11 Promotes Metastatis and Cell Growth of Prostate Cancer by CBX4 Complex Binding to Top2α. Cancer Manag Res 2021; 13:913-923. [PMID: 33564266 PMCID: PMC7866953 DOI: 10.2147/cmar.s270144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Studies have confirmed that parts of the non-coding genes in the human genome play an important role in the pathogenesis and metastasis of prostate cancer. Among them, long non-coding RNAs (lncRNAs) are vitally involved in the biological regulation of prostate cancer. In addition, lncRNAs are closely associated with the recurrence, metastasis and prognosis of prostate cancer. However, the molecular pathogenesis of lncRNAs in regulating cell growth and metastasis of prostate cancer remains unclear. Therefore, this study was designed to explore the function and mechanism of lncRNA RAMS11 in cell growth and metastasis of prostate cancer. Methods Prostate cancer and para-carcinoma tissue samples were obtained from 42 patients who were diagnosed from March 2013 to September 2014 at Quanzhou First Hospital Affiliated to Fujian Medical University. Microarray experiments and real-time polymerase chain reaction (PCR) measured the expression of lncRNA. RWPE-2, LNCap, PC3 and DU145 cells were used for an in vitro model. Results The expression of lncRNA RAMS11 was up-regulated in prostate cancer tissue samples. LncRNA RAMS11 promoted cell growth and metastasis of prostate cancer cells. Down-regulation of lncRNA RAMS11 attenuated cell growth and metastasis of prostate cancer cells. We also demonstrated that lncRNA RAMS11 bound to CBX4 to activate expression of Top2α. LncRNA RAMS11 promoted tumor growth of prostate cancer in the mouse model. The inhibition of CBX4 attenuated the pro-cancer effects of lncRNA AMS11 in prostate cancer cells, while the activation of Top2α attenuated the anti-cancer effects of si-lncRNA RAMS11 in prostate cancer cells. Discussion Our results indicated that lncRNA RAMS11 promoted cell growth and metastasis of prostate cancer by CBX4 complex via binding to Top2α, and might be developed for the treatment of prostate cancer.
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Affiliation(s)
- Zhixiong Zheng
- Urology Department, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China
| | - Kaiyan Qiu
- Urology Department, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China
| | - Weiwen Huang
- Urology Department, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China
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12
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Davis JW. The great escape: A tale of the visiting professor’s Artful Dodge. BJUI COMPASS 2021; 2:3-6. [PMID: 35474663 PMCID: PMC8988782 DOI: 10.1002/bco2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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13
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Ductal Prostate Cancers Demonstrate Poor Outcomes with Conventional Therapies. Eur Urol 2020; 79:298-306. [PMID: 33279304 DOI: 10.1016/j.eururo.2020.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Ductal prostate adenocarcinoma (DAC) is a rare, aggressive, histologic variant of prostate cancer that is treated with conventional therapies, similar to high-risk prostate adenocarcinoma (PAC). OBJECTIVE To assess the outcomes of men undergoing definitive therapy for DAC or high-risk PAC and to explore the effects of androgen deprivation therapy (ADT) in improving the outcomes of DAC. DESIGN, SETTING, AND PARTICIPANTS A single-center retrospective review of all patients with cT1-4/N0-1 DAC from 2005 to 2018 was performed. Those undergoing radical prostatectomy (RP) or radiotherapy (RTx) for DAC were compared with cohorts of high-risk PAC patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Metastasis-free survival (MFS) and overall survival (OS) rates were analyzed using Kaplan-Meier and Cox regression models. RESULTS AND LIMITATIONS A total of 228 men with DAC were identified; 163 underwent RP, 34 underwent RTx, and 31 had neoadjuvant therapy prior to RP. In this study, 163 DAC patients and 155 PAC patients undergoing RP were compared. Similarly, 34 DAC patients and 74 PAC patients undergoing RTx were compared. DAC patients undergoing RP or RTx had worse 5-yr MFS (75% vs 95% and 62% vs 93%, respectively, p < 0.001) and 5-yr OS (88% vs 97% and 82% vs 100%, respectively, p < 0.05) compared with PAC patients. In the 76 men who received adjuvant/salvage ADT after RP, DAC also had worse MFS and OS than PAC (p < 0.01). A genomic analysis revealed that 10/11 (91%) DACs treated with ADT had intrinsic upregulation of androgen-resistant pathways. Further, none of the DAC patients (0/15) who received only neoadjuvant ADT prior to RP had any pathologic downgrading. The retrospective nature was a limitation. CONCLUSIONS Men undergoing RP or RTx for DAC had worse outcomes than PAC patients, regardless of the treatment modality. Upregulation of several intrinsic resistance pathways in DAC rendered ADT less effective. Further evaluation of the underlying biology of DAC with clinical trials is needed. PATIENT SUMMARY This study demonstrated worse outcomes among patients with ductal adenocarcinoma of the prostate than among high-grade prostate adenocarcinoma patients, regardless of the treatment modality.
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