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Huang H, Zou S, Wan J, Zeng X, Wang S, Hu Z, Zhu X, Yang C. 68Ga-PSMA PET/CT and 18F-FDG PET/CT in the diagnosis of prostatic ductal cancer. Urol Oncol 2024:S1078-1439(24)00564-7. [PMID: 39098476 DOI: 10.1016/j.urolonc.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/30/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
PURPOSES To explore the characteristics of PSMA PET/CT and FDG PET/CT images in prostatic ductal adenocarcinoma (DA) patients. METHODS We retrospectively enrolled prostatic DA patients with PET/CT scans at Tongji Hospital from 2018 to 2022. Patients with prostatic acinar adenocarcinoma (AA) and benign pathology (BP) were enrolled by 1:1 matching. Differences in the uptake of primary and metastatic foci on PET among the groups were analyzed. RESULTS A total of 42 patients were enrolled: 14 in each group. In primary foci, the mean PSMA uptake in the DA group was lower than that in the AA group (14.2 ± 9.6 vs. 27.1 ± 14.3, P = 0.009) and greater than that in the BP group (14.2 ± 9.6 vs. 4.7 ± 1.3, P = 0.003). The AUCs of the DA-AA ROC curve and DA-BP ROC curve were 0.781 and 0.872, respectively. The median PSMA uptake of metastatic lymph nodes in the DA group was lower than that in the AA group (5.6 vs. 14.2, P = 0.033), with no significant difference in metastatic bone lesions (9.5 vs 19.1, P = 0.485). No significant difference was found in the FDG uptake of primary and metastatic foci between the DA and AA groups (P > 0.05). CONCLUSION Prostatic DA has greater PSMA uptake than BP diseases, but lower uptake in both primary foci and metastatic lymph nodes than AA on PSMA PET/CT, aiding in the differential diagnosis of DA, AA and BP diseases. Clinicians should combine traditional imaging with PSMA PET/CT to avoid underestimating the clinical stage of DA patients.
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Affiliation(s)
- Haijun Huang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sijuan Zou
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Wan
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaohua Zhu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Chunguang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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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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Cui Y, Lin J, Sun D, Zhang H, Diao T, Fu Q. Nomogram for predicting the overall survival and cancer-specific survival of patients with intraductal carcinoma of the prostate. J Cancer Res Clin Oncol 2024; 150:45. [PMID: 38281261 PMCID: PMC10822789 DOI: 10.1007/s00432-023-05582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Intraductal carcinoma of the prostate (IDC-P) is a histological subtype that differs from conventional acinar adenocarcinoma in terms of its origin, appearance, and pathological features. For IDC-P, there is currently no recognized best course of action, and its prognosis is unclear. The goal of this study is to analyze independent prognostic factors in IDC-P patients and to develop and validate a nomogram to predict overall survival (OS) and cancer-specific survival (CSS). METHODS Clinical data for IDC-P patients were collected from the Surveillance, Epidemiology, and End Results database. To identify the independent variables influencing prognosis, multivariate Cox regression analysis was performed. A nomogram model was created utilizing these variables after comparing the variations in OS and CSS among various subgroups using Kaplan‒Meier curves. Internal validation of the nomograms was verified using the bootstrap resampling method. RESULTS The study included 280 IDC-P patients in total. Marital status, summary stage, grade, and the presence of lung metastases were significant factors impacting OS, and CSS was significantly influenced by marital status, summary stage, AJCC stage, the presence of lung metastases, the presence of bone metastases, and PSA according to univariate and multivariate Cox regression models (P < 0.05). Nomogram models were created to estimate OS and CSS using these parameters. The OS prediction model's C-index was 0.744, whereas the CSS prediction model's C-index was 0.831. CONCLUSION We developed and verified nomogram models for the prediction of 1-, 3-, and 5-year OS and CSS in patients with IDC-P. These nomograms serve as a resource for evaluating patient prognosis, therapy, and diagnosis, ultimately improving clinical decision-making accuracy.
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Affiliation(s)
- Yongqiang Cui
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Junyang Lin
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Dingqi Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Hui Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China.
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China.
- Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China.
- Key Laboratory of Urinary Diseases in Universities of Shandong Shandong First Medical University, Jinan, 250021, China.
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Wang X, Zhou L, Qi L, Zhang Y, Yin H, Gan Y, Gao X, Cai Y. High GLUT1 membrane expression and low PSMA membrane expression in Ductal Adenocarcinoma and Intraductal Carcinoma of the prostate. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00759-y. [PMID: 38007533 DOI: 10.1038/s41391-023-00759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Both Ductal Adenocarcinoma (DAC) and Intraductal Carcinoma (IDC) of the prostate are generally associated with aggressive clinical behavior and poor prognosis, which were linked with discordant FDG positivity and low Prostate-Specific Membrane Antigen (PSMA) expression. A recent study only cited a DAC patient with low 68Ga-PSMA-11 PET/CT uptake but high 18F-FDG PET/CT uptake, however, there is lack of directly compared articles nor large data sets. Hence, the objective of this study was to investigate the expression of PSMA and GLUT1 in DAC and IDC-P patients. METHODS The study was conducted on 87 DAC or/and IDC-P patients without any treatment and 97 PAC patients with a Gleason score ≥8 of prostate biopsies and prostatectomy samples between August 2017 and August 2022. We performed immunohistochemical staining and scoring of various cancer component samples from the patients to reflect the protein expression levels of PSMA and GLUT1. RESULTS PSMA expression in PAC was significantly higher than in DAC/IDC-P (141.2 vs 78.6, p < 0.001). There was no significant difference in PSMA expression between DAC/IDC-P and adjacent PAC (78.6 vs 93.4, p = 0.166). GLUT1 expression was higher in DAC/IDC-P than in adjacent PAC (68.6 vs 51.3, p = 0.007), but was still lower than that in pure PAC (68.6 vs 93.1, p = 0.0014). It is worth noting that GLUT1 membrane expression in DAC/IDC-P was significantly increased than in pure PAC (13.0 vs 6.6, p = 0.025), and in PAC adjacent to DAC/IDC-P (13.0 vs 2.0, p < 0.001). CONCLUSIONS In DAC/IDC-P tissues, PSMA expression is low, while GLUT1 expression, especially GLUT1 membrane expression is high. These findings imply that DAC/IDC-P may have higher glucose metabolic and raise interest in targeting membrane GLUT1 as a novel anticancer strategy for DAC/IDC-P and other prostate cancer with high glucose metabolism.
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Affiliation(s)
- Xingming Wang
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Li Zhou
- Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Qi
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ye Zhang
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hongling Yin
- Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Gan
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Xiaomei Gao
- Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Yi Cai
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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5
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Marra G, van Leenders GJLH, Zattoni F, Kesch C, Rajwa P, Cornford P, van der Kwast T, van den Bergh RCN, Briers E, Van den Broeck T, De Meerleer G, De Santis M, Eberli D, Farolfi A, Gillessen S, Grivas N, Grummet JP, Henry AM, Lardas M, Lieuw M, Linares Espinós E, Mason MD, O'Hanlon S, van Oort IM, Oprea-Lager DE, Ploussard G, Rouvière O, Schoots IG, Stranne J, Tilki D, Wiegel T, Willemse PPM, Mottet N, Gandaglia G. Impact of Epithelial Histological Types, Subtypes, and Growth Patterns on Oncological Outcomes for Patients with Nonmetastatic Prostate Cancer Treated with Curative Intent: A Systematic Review. Eur Urol 2023:S0302-2838(23)02654-4. [PMID: 37117107 DOI: 10.1016/j.eururo.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/11/2023] [Accepted: 03/14/2023] [Indexed: 04/30/2023]
Abstract
CONTEXT The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed. OBJECTIVE To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent. EVIDENCE ACQUISITION A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021. EVIDENCE SYNTHESIS We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy. CONCLUSIONS Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers. PATIENT SUMMARY We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Claudia Kesch
- Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Gert De Meerleer
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Maria De Santis
- Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; Department of Urology, Charité Universitätsmedizin, Berlin, Germany
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; University of Bern, Bern, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Caulfield North, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Matt Lieuw
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | - Inge M van Oort
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | - Guillaume Ploussard
- La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Onocopole, Toulouse, France
| | - Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johan Stranne
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenborg, Sweden
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolas Mottet
- Centre Hospitalo-Universitaire de Saint Etienne, Saint Etienne, France
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Kawamura H, Nakamura K, Yoshioka Y, Itasaka S, Tomita N, Onishi M, Iwata H, Aizawa T, Kikuchi K, Nagata K, Nakamura K, Nishioka K, Ishiyama H, Ueno S, Kokubo M, Yamazaki H, Watanabe K, Toyoda T, Akimoto T. Radiotherapy for ductal carcinoma of the prostate: an analysis based on the Japanese radiation oncology study group survey. Jpn J Clin Oncol 2023; 53:146-152. [PMID: 36478251 DOI: 10.1093/jjco/hyac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The clinical characteristics of prostate ductal carcinoma is still unclear, and treatment strategy has not yet been established due to its rarity. Therefore, we conducted a multicenter survey of radiation therapy for prostate ductal carcinoma in Japan. METHOD Data of patients with ductal carcinoma of the prostate treated with radiation therapy between 1996 and 2018 were extracted from the database of each facility. RESULTS Fifty-two treatment records of 41 patients were collected from nine institutions. The treatment purpose and situations were varied curative intent to palliation. Twenty-eight patients received curative treatments. The median follow-up period of these patients was 68 months. Androgen deprivation therapy was combined with radiation therapy in 26 cases (93%). X-ray and particle irradiation was used. Radiation dose range was 63-78 Gy; 5-year overall survival, progression-free survival and biochemical relapse-free survival were 87.0, 79.3 and 79.3%, respectively. One patient experienced Grade 3 radiation proctitis and one experienced Grade 3 radiation cystitis. There were no Grade 4 or worse adverse events. CONCLUSION Most patient received similar treatment with adenocarcinoma of prostate, and the clinical results were compatible. For more reliable evidence, further studies are required.
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Affiliation(s)
| | - Katsumasa Nakamura
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Itasaka
- Department of Radiation Oncology, Kurashiki Central Hospital, Okayama, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Koyo Kikuchi
- Department of Radiation Oncology, Iwate Medical University, Iwate, Japan
| | - Kenji Nagata
- Department of Radiation Oncology, Ishikiriseiki Hospital, Higashi-Osaka, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shuichi Ueno
- Department of Radiation Oncology, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenta Watanabe
- Department of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan
| | - Tatsuya Toyoda
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
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7
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Kobayashi H, Kosaka T, Nakamura K, Kimura T, Nishihara H, Oya M. Genomic analysis of aggressive ductal adenocarcinoma of the prostate. Cancer Med 2022; 12:8445-8451. [PMID: 36573306 PMCID: PMC10134333 DOI: 10.1002/cam4.5573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Genomic profile analysis using next-generation sequencing can potentially elucidate the pathogenesis of rare cancers. Ductal adenocarcinoma, a rare subtype of prostate cancer, has an aggressive nature. This is the first study to analyze the genomic profile of ductal adenocarcinoma in an Asian population. METHODS We identified 12 patients newly diagnosed with ductal adenocarcinoma of the prostate at two hospitals, and nine patients (75.0%) had the pure type. Genomic assessment was performed using either the PleSSision testing platform or FoundationOne CDx. RESULTS At least one genomic alteration occurred in 11 patients (91.7%), and the most frequently mutated gene was tumor suppressor protein p53 (TP53), which was found in six cases (50.0%). Alterations characteristic of this cohort were found in four cases (33.3%) of retinoblastoma transcriptional corepressor 1 (RB1), which was only observed in the pure type. Compared to previous study results, the frequency of genetic alterations in the phosphoinositide 3-kinase (PI3K) pathway (n = 3; 25.0%) and Wnt-β-catenin pathway (n = 5; 41.7%) was comparable, but no alterations in the DNA damage repair (DDR) pathway were observed. None of the patients presented high tumor mutation burden or microsatellite instability. CONCLUSIONS We found that the Asian cohort with ductal adenocarcinoma had actionable alterations, and a high frequency of alterations in TP53 and RB1 reflected the aggressive nature of the tumor. Genetic analysis using next-generation sequencing is expected to help elucidate the pathogenesis 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 Kanagawa Japan
| | - Takeo Kosaka
- Department of Urology Keio University School of Medicine Tokyo Japan
| | - Kohei Nakamura
- Genomics Unit, Keio Cancer Center Keio University School of Medicine Tokyo Japan
| | - Tokuhiro Kimura
- Division of Diagnostic Pathology Saiseikai Yokohamashi Tobu Hospital Kanagawa Japan
| | - Hiroshi Nishihara
- Genomics Unit, Keio Cancer Center Keio University School of Medicine Tokyo Japan
| | - Mototsugu Oya
- Department of Urology Keio University School of Medicine Tokyo Japan
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8
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Ductal prostate cancer: Clinical features and outcomes from a multicenter retrospective analysis and overview of the current literature. Curr Urol 2022; 16:218-226. [PMID: 36714233 PMCID: PMC9875213 DOI: 10.1097/cu9.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 02/01/2023] Open
Abstract
Objective The 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 methods Patients 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. Results Eighty-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). Conclusions Our 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.
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9
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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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10
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Kench JG, Amin MB, Berney DM, Compérat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Moch H, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tsuzuki T, Turjalic S, van der Kwast TH, Zhou M, Srigley JR. WHO Classification of Tumours fifth edition: evolving issues in the classification, diagnosis, and prognostication of prostate cancer. Histopathology 2022; 81:447-458. [PMID: 35758185 PMCID: PMC9542779 DOI: 10.1111/his.14711] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/29/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
The fifth edition of the WHO Classification of Tumours of the Urinary and Male Genital Systems encompasses several updates to the classification and diagnosis of prostatic carcinoma as well as incorporating advancements in the assessment of its prognosis, including recent grading modifications. Some of the salient aspects include: (1) recognition that prostatic intraepithelial neoplasia (PIN)-like carcinoma is not synonymous with a pattern of ductal carcinoma, but better classified as a subtype of acinar adenocarcinoma; (2) a specific section on treatment-related neuroendocrine prostatic carcinoma in view of the tight correlation between androgen deprivation therapy and the development of prostatic carcinoma with neuroendocrine morphology, and the emerging data on lineage plasticity; (3) a terminology change of basal cell carcinoma to "adenoid cystic (basal cell) cell carcinoma" given the presence of an underlying MYB::NFIB gene fusion in many cases; (4) discussion of the current issues in the grading of acinar adenocarcinoma and the prognostic significance of cribriform growth patterns; and (5) more detailed coverage of intraductal carcinoma of prostate (IDC-P) reflecting our increased knowledge of this entity, while recommending the descriptive term atypical intraductal proliferation (AIP) for lesions falling short of IDC-P but containing more atypia than typically seen in high-grade prostatic intraepithelial neoplasia (HGPIN). Lesions previously regarded as cribriform patterns of HGPIN are now included in the AIP category. This review discusses these developments, summarising the existing literature, as well as the emerging morphological and molecular data that underpins the classification and prognostication of prostatic carcinoma.
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Affiliation(s)
- James G Kench
- Department of Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred Hospital, NSW Health PathologyCamperdownNew South WalesAustralia
- The University of SydneyCamperdownNew South WalesAustralia
| | - Mahul B Amin
- The University of Tennessee Health Science CenterMemphisTNUSA
| | - Daniel M Berney
- Department of Cellular Pathology, Bartshealth NHS TrustRoyal London HospitalLondonUK
| | - Eva M Compérat
- Department of PathologyUniversity of ViennaViennaAustria
| | - Ian A Cree
- International Agency for Research on CancerLyonFrance
| | - Anthony J Gill
- The University of SydneyCamperdownNew South WalesAustralia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific HighwaySt LeonardsNew South WalesAustralia
| | - Arndt Hartmann
- Institute of PathologyUniversity Hospital Erlangen, Friedrich‐Alexander‐University Erlangen‐NürnbergErlangenGermany
| | - Santosh Menon
- Department of PathologyTata Memorial Centre, Homi Bhabha National InstituteMumbaiIndia
| | - Holger Moch
- Department of Pathology and Molecular PathologyUniversity Hospital ZurichZurichSwitzerland
| | - George J Netto
- Heersink School of MedicineThe University of Alabama at BirminghamBirminghamALUSA
| | - Maria R Raspollini
- Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly
| | - Mark A Rubin
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
| | - Puay Hoon Tan
- Division of Pathology, Singapore General HospitalSingaporeSingapore
| | - Toyonori Tsuzuki
- Department of Surgical PathologyAichi Medical University HospitalNagakuteJapan
| | - Samra Turjalic
- Skin and Renal UnitsRoyal Marsden NHS Foundation TrustLondonUK
- Cancer Dynamics LaboratoryThe Francis Crick InstituteLondonUK
| | - Theo H van der Kwast
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Ming Zhou
- Pathology and Laboratory MedicineTufts Medical CenterBostonMAUSA
| | - John R Srigley
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
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11
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Lindh C, Samaratunga H, Delahunt B, Bergström R, Chellappa V, Yaxley J, Lindberg J, Egevad L. Ductal and acinar components of mixed prostatic adenocarcinoma frequently have a common clonal origin. Prostate 2022; 82:576-583. [PMID: 35049068 PMCID: PMC9306900 DOI: 10.1002/pros.24304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ductal adenocarcinoma (DA) is an aggressive subtype of prostate cancer. It is most commonly seen in mixed tumors together with conventional acinar adenocarcinoma (AA). The genetic profile of DA and its clonal origin is not fully characterized. OBJECTIVE To investigate whether DA represents a distinct genetic subtype and to investigate the somatic relationship between the ductal and acinar components of mixed cancers. DESIGN, SETTING, AND PARTICIPANTS In 17 radical prostatectomy specimens ductal and acinar tumor components from the same tumor foci were dissected. DNA was extracted and genomic sequencing performed. After exclusion of two cases with low cell yield, 15 paired samples remained for analysis. RESULTS In 12 of 15 cases a common somatic denominator was identified, while three cases had clonally separate components. In DA, TMPRSS2-ERG gene fusions were detected in 47% (7/15), clonal FOXA1 alterations in 33% (5/15) and SPOP alterations in 27% (4/15) of cases. In one case KIAA1549-BRAF fusion was identified. Genome doubling events, resulting in an increased ploidy, were identified in the DA in 53% (8/15) of cases, but not seen in any AA. PTEN and CTNNB1 alterations were enriched in DA (6/15) but not seen in any AA. No cancers showed microsatellite instability or high tumor mutation burden. CONCLUSIONS Ductal and acinar prostate adenocarcinoma components of mixed tumors most often share the same origin and are clonally related. DA components in mixed tumor often exhibit genome doubling events resulting in aneuploidy, consistent with the aggressive nature of high grade prostate cancer.
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Affiliation(s)
- Claes Lindh
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | | | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health SciencesUniversity of OtagoWellingtonNew Zealand
| | - Rebecka Bergström
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Venkatesh Chellappa
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - John Yaxley
- Wesley Urology ClinicBrisbaneQueenslandAustralia
| | - Johan Lindberg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Lars Egevad
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
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12
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Ma C, Downes M, Jain R, Ientilucci M, Fleshner N, Perlis N, van der Kwast T. Prevalence of adverse pathology features in grade group 2 prostatectomy specimens with syn- or metachronous metastatic disease. Prostate 2022; 82:345-351. [PMID: 34878188 DOI: 10.1002/pros.24279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND To validate the importance of recently established adverse histopathology features (cribriform pattern and intraductal carcinoma) as contra-indication for deferred treatment of Gleason score 7 (3 + 4) (grade group [GG] 2) prostate cancer, we investigated their frequency in GG2 radical prostatectomies with syn- or metachronous metastatic disease. METHODS GG2 prostatectomy specimens of patients with concomitant lymph node metastasis or distant metastasis at follow-up were identified in a clinical database of a tertiary care center and their pathology was reviewed for pathological stage, lymphovascular invasion, Gleason grade 4 subpatterns, presence of tertiary grade 5, and ductal adenocarcinoma histology. A control group of 99 GG2 prostatectomy specimens who had no metastatic disease (controls) was reviewed for the same adverse pathological features. RESULTS Of 1860 GG2 prostatectomy specimens (operated between 2002 and 2020), 45 (2.4%) had concurrent regional lymph node metastases or distant metastases at follow-up. Pathological stage distribution of cases and controls was 24% and 79% pT2, 42% and 15% pT3a, 33% and 6.1% pT3b -T4, respectively (p < 0.001). Eleven of 45 cases (24%) had ≤10% Gleason grade 4 component. Cribriform pattern or intraductal carcinoma was present in 84% of cases versus 34% of controls (p < 0.001), tertiary grade 5 in 16% of cases versus 5% controls (p = 0.05) and ductal adenocarcinoma in 16% of cases versus 2% of controls (p = 0.004). Among the seven cases without cribriform or intraductal carcinoma, two displayed ductal adenocarcinoma features. CONCLUSIONS Well-established unfavorable histopathologic features (intraductal and cribriform pattern carcinoma, ductal adenocarcinoma) are represented in about 90% of GG2 prostate cancers with local or distant metastatic disease and are much less common (38%) in those without metastatic disease. Strikingly, about 25% of GG2 prostatectomy cases with metastatic disease had an organ-confined disease and/or a small percentage of Gleason grade 4 pattern. This further emphasizes the relative importance of these adverse histopathological features (cribriform, intraductal, and ductal adenocarcinoma) rather than percentage Gleason grade 4 as contra-indicator of deferred treatment for patients with GG2 prostate cancer.
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Affiliation(s)
- Christopher Ma
- Department of Pathology, Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michelle Downes
- Department of Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rahi Jain
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Marc Ientilucci
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Ontario, Canada
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13
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Russell DH, Epstein JI. Intraductal Adenocarcinoma of the Prostate With Cribriform or Papillary Ductal Morphology: Rare Biopsy Cases Lacking Associated Invasive High-grade Carcinoma. Am J Surg Pathol 2022; 46:233-240. [PMID: 34619708 DOI: 10.1097/pas.0000000000001819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prostatic duct adenocarcinoma, characterized by pseudostratified columnar epithelium, has historically been considered invasive carcinoma, although it may commonly have an intraductal component. Usual (acinar) intraductal carcinoma of the prostate (IDC-P) is a noninvasive high-risk lesion typically associated with high-grade, high-stage prostate cancer. Whereas there have been rare biopsy studies of pure acinar IDC-P or IDC-P associated with only low-grade carcinoma, there have been no analogous series of IDC-P with cribriform or papillary ductal morphology on biopsy unassociated with invasive high-grade carcinoma. We identified 14 patients with biopsies showing IDC-P with ductal morphology, defined as prostatic duct adenocarcinoma confined to glands/ducts with immunohistochemically proven retention of basal cells. Our series includes 12 patients with pure IDC-P and 2 patients with concurrent low-volume Grade Group 1 invasive cancer in unassociated cores. Three patients underwent radical prostatectomy: 2/3 had high-grade cancer in their resection specimen (Grade Group 3, Grade Group 5), including 1 with advanced stage and nodal metastases; 1/3 had Grade Group 1 organ-confined carcinoma and spatially distinct IDC-P with ductal morphology. Five men had only follow-up biopsies: 2/5 had cancer (Grade Group 2, Grade Group 4); 1/5 had IDC-P (on 2 repeat biopsies); and 2/5 had benign transurethral resection of the prostate. In all 5 cases with invasive cancer, the invasive portion was comprised purely of acinar morphology; no invasive ductal component was identified. Five patients did not have follow-up biopsies and were treated with radiation therapy±androgen deprivation. One patient had no follow-up information. In an analogous situation to acinar IDC-P, we propose that rarely there is a precursor form of ductal adenocarcinoma that can exist without concurrent invasive high-grade carcinoma and propose the term "IDC-P with ductal morphology," consistent with the terminology for acinar prostate adenocarcinoma. Until more evidence is accumulated, we recommend reporting and treating patients with IDC-P with ductal morphology in a manner analogous to those with acinar IDC-P. As with pure IDC-P with acinar morphology, we would also recommend not grading pure IDC-P with ductal morphology. Finally, we propose a new addition to the diagnostic criteria of IDC-P to include intraductal lesions with ductal morphology consisting of papillary fronds or cribriform lesions lined by cytologically atypical pseudostratified epithelium.
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Affiliation(s)
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
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14
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Kryvenko ON, Iakymenko OA, De Lima Guido LP, Bhattu AS, Merhe A, Mouzannar A, Briski LM, Oymagil I, Lugo I, Nemov I, Ritch CR, Kava BR, Punnen S, Jorda M, Parekh DJ, Gonzalgo ML. Prostatic Ductal Adenocarcinoma Controlled for Tumor Grade, Stage, and Margin Status Does Not Independently Influence the Likelihood of Biochemical Recurrence in Localized Prostate Cancer After Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:1012-1017. [PMID: 34739539 DOI: 10.5858/arpa.2021-0048-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. OBJECTIVE.— To investigate if PDA is independently associated with worse biochemical recurrence (BCR)-free survival after radical prostatectomy. DESIGN.— A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. RESULTS.— Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3-4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. CONCLUSIONS.— Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA.
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Luiz P De Lima Guido
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Amit S Bhattu
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Merhe
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Mouzannar
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Irfan Oymagil
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Bruce R Kava
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
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15
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Lawrence MG, Porter LH, Clouston D, Murphy DG, Frydenberg M, Taylor RA, Risbridger GP. Knowing what's growing: Why ductal and intraductal prostate cancer matter. Sci Transl Med 2021; 12:12/533/eaaz0152. [PMID: 32132214 DOI: 10.1126/scitranslmed.aaz0152] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
Prostate cancer is a common malignancy, but only some tumors are lethal. Accurately identifying these tumors will improve clinical practice and instruct research. Aggressive cancers often have distinctive pathologies, including intraductal carcinoma of the prostate (IDC-P) and ductal adenocarcinoma. Here, we review the importance of these pathologies because they are often overlooked, especially in genomics and preclinical testing. Pathology, genomics, and patient-derived models show that IDC-P and ductal adenocarcinoma accompany multiple markers of poor prognosis. Consequently, "knowing what is growing" will help translate preclinical research to pinpoint and treat high-risk prostate cancer in the clinic.
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Affiliation(s)
- Mitchell G Lawrence
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia.,Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Laura H Porter
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | | | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC 3000, Australia.,Epworth HealthCare, Melbourne, VIC 3000, Australia
| | - Mark Frydenberg
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia.,Australian Urology Associates, Melbourne, VIC 3000, Australia.,Department of Urology, Cabrini Health, Malvern, VIC 3144, Australia
| | - Renea A Taylor
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia.,Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Gail P Risbridger
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia. .,Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
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16
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Liu M, Jin K, Qiu S, Xu P, Zhang M, Cai W, Zheng X, Yang L, Wei Q. Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy. Asian J Urol 2021; 8:227-234. [PMID: 33996481 PMCID: PMC8099636 DOI: 10.1016/j.ajur.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/08/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Objective To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively. Methods The cohorts included a total of 528 patients from the Surveillance, Epidemiology and End Results (SEER) database, 354 receiving RP and 174 receiving RT. Cox proportional hazards regressions were performed to assess cancer specific mortality (CSM) and overall mortality (OM) between treatment groups. A competing risk analysis was further conducted. Subgroup analyses by age and level of prostate-specific antigen (PSA) were performed. Propensity score matching was implemented. Results Patients managed with RP had lower risks of CSM and OM compared with RT (before matching: Hazard ratio [HR]=0.24, 95% confidence interval [CI] 0.13–0.47 and HR=0.26, 95% CI 0.17–0.40, respectively; after matching: HR=0.18, 95% CI 0.04–0.82 and HR=0.28, 95% CI 0.11–0.70, accordingly). Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly (HR=0.18, 95% CI 0.06–0.57, p<0.01 and HR=0.17, 95% CI 0.06–0.54, p<0.01). Conclusion Among patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.
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Affiliation(s)
- Mengzhu Liu
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Jin
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China.,Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China
| | - Pengyong Xu
- Institute of Urology, Department of Urology, the First People's Hospital, Yantai, China
| | - Mingming Zhang
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wufeng Cai
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Zheng
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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17
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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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18
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Tan YG, Khalid F, Huang HH, Chen K, Tay KJ, Lau WKO, Cheng CWS, Ngo NT, Yuen JSP. Prostatic ductal adenocarcinoma variant predicts worse pathological and oncological outcomes: Insight from over 1000 consecutive patients from a large prospective uro-oncology registry. Prostate 2021; 81:242-251. [PMID: 33428259 DOI: 10.1002/pros.24100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate if prostatic ductal adenocarcinoma (PDA) independently predicts poorer pathological and oncological outcomes after radical prostatectomy (RP). METHODS AND MATERIALS Utilizing a large prospective uro-oncology registry, clinicopathological parameters of 1027 consecutive patients who underwent RP (2008-2017) were recorded. Oncological outcomes were determined by failure to achieve unrecordable PSA postoperatively and biochemical failure (BCF). RESULTS PDA was present in 79 (7.7%) patients, whereas 948 (92.3%) patients had conventional prostatic acinar adenocarcinoma (PAA). Patients with PDA were older (mean 64.4 vs. 62.8-years old; p = .045), had higher PSA at diagnosis (mean 12.53 vs. 10.80 ng/ml; p = .034), and a higher percentage of positive biopsy cores (mean 39.34 vs. 30.53%; p = .006). Compared to PAA, PDA exhibited a more aggressive tumor biology: (1) Grade groups 4 or 5 (26.6 vs. 9.4%, p < .001), (2) tumor multifocality (89.9 vs. 83.6%; p = .049), and (3) tumor size (mean 2.97 vs. 2.00 cm; p < .001). On multivariate analysis, PDA was independently associated with locally advanced disease (p = .002, hazard ratio [HR]: 2.786, 95% confidence interval [CI]: 1.473-5.263), with a trend towards positive surgical margins (p = .055) and nodal involvement (p = .061). Translating the poorer pathological features to oncological outcomes, presence of PDA independently predicted less likelihood of achieving unrecordable PSA (p = .019, HR: 2.368, 95% CI: 1.152-4.868, and higher BCF (p = .028, HR: 1.918, 95% CI: 1.074-3.423). Subgroup analysis demonstrated that a higher ductal component greater than 15% proportionally predicted worse oncological outcomes, with a shorter time to BCF of 14.3 months compared to 19.8 months in patients with ductal component lesser than 15% (p = .040, HR: 2.660, 95% CI: 1.046-6.757). CONCLUSION PDA is independently associated with adverse pathological and oncological outcomes after RP. A higher proportion of PDA supports a higher BCF rate with a shorter time interval. An aggressive extirpative approach with close monitoring of postoperative serum PSA levels is warranted for these patients.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Farhan Khalid
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Weber K O Lau
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Nye Thane Ngo
- Department of Pathology, Singapore General Hospital, Singapore
| | - John S P Yuen
- Department of Urology, Singapore General Hospital, Singapore
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19
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Ranasinha N, Omer A, Philippou Y, Harriss E, Davies L, Chow K, Chetta PM, Erickson A, Rajakumar T, Mills IG, Bryant RJ, Hamdy FC, Murphy DG, Loda M, Hovens CM, Corcoran NM, Verrill C, Lamb AD. Ductal adenocarcinoma of the prostate: A systematic review and meta-analysis of incidence, presentation, prognosis, and management. BJUI COMPASS 2021; 2:13-23. [PMID: 35474657 PMCID: PMC8988764 DOI: 10.1002/bco2.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023] Open
Abstract
Context Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome. Objectives To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC. Materials and methods We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms "prostate ductal adenocarcinoma" OR "endometriod adenocarcinoma of prostate" and variations of each. Results Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all P-values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC. Conclusion When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type. Patient summary Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up.
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Affiliation(s)
- Nithesh Ranasinha
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Altan Omer
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Yiannis Philippou
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Eli Harriss
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - Lucy Davies
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Ken Chow
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | | | - Andrew Erickson
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Timothy Rajakumar
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Ian G. Mills
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Richard J. Bryant
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Declan G. Murphy
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVICAustralia
| | - Massimo Loda
- Dana Farber Cancer InstituteHarvardMAUSA
- Weill Cornell Medical SchoolNew YorkNYUSA
| | - Christopher M. Hovens
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | - Niall M. Corcoran
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | - Clare Verrill
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Alastair D. Lamb
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
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20
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The Role of Radiotherapy Among Patients With Prostate Ductal Adenocarcinoma. Clin Genitourin Cancer 2020; 19:e41-e50. [PMID: 33616071 DOI: 10.1016/j.clgc.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to perform a Surveillance, Epidemiology, and End Results (SEER) analysis on the effect of radiotherapy (RT) on survival among patients with prostate ductal adenocarcinoma (DA), a rare variant of prostate cancer. PATIENTS AND METHODS Cases of T1 to 4 N0 M0 prostate DA diagnosed between 2004 and 2013 were extracted from SEER. The association between categorical variables and radiation therapy was assessed for statistical significance using the χ2 test or Fisher exact test. Difference in continuous variables across the RT groups was assessed for statistical significance using the 2-sample t test or non-parametric test. The distribution of overall survival (OS) and disease-specific survival (DSS) between the RT groups was assessed using the Kaplan-Meier method and the log rank test and after propensity matching. The association between hazards of death (HR) and covariates was examined using Cox proportional hazards model. A 2-sided P-value of .05 was used to determine statistical significance. RESULTS A total of 205 patients met inclusion criteria. On univariate analysis, RT was associated with significant improvement in OS and DSS. On multivariate Cox regression, RT significantly decreased risk of death for both OS and DSS (HR, 0.516; 95% confidence interval [CI], 0.273-0.978 and HR, 0.232; 95% CI, 0.082-0.658, respectively). After propensity score matching, RT demonstrated a persistent improvement in both OS and DSS. CONCLUSIONS RT decreased risk of death for both OS and DSS in patients with node-negative, nonmetastatic prostate DA on multivariable analysis. RT was also associated with improved OS and DSS after propensity matching.
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21
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Non-metastatic ductal adenocarcinoma of the prostate: pattern of care from an uro-oncology multidisciplinary group. World J Urol 2020; 39:1161-1170. [PMID: 32591899 DOI: 10.1007/s00345-020-03315-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To retrospectively review our 20 year experience of multidisciplinary management of non-metastatic ductal prostate cancer (dPC), a rare but aggressive histological subtype of prostate cancer whose optimal therapeutic approach is still controversial. METHODS Histologically confirmed dPC patients undergoing primary, curative treatment [radical prostatectomy (RP), external beam radiotherapy (EBRT), and androgen deprivation therapy (ADT)] were included, and percentage of ductal and acinar pattern within prostate samples were derived. Survival outcomes were assessed using the subdistribution hazard ratio (SHR) and Fine-and-Gray model. RESULTS From January 1997 to December 2016, 81 non-metastatic dPC fitted selection criteria. Compared to surgery alone, SHR for progression-free survival and cancer-specific mortality were 2.8 (95% CI 0.6-13.3) and 1.3 (95% CI 0.1-16.2) for exclusive EBRT, 2.7 (95% CI 0.6-13.0) and 6.5 (95% CI 0.6-69.8) for adjuvant EBRT, 4.9 (95% CI 0.7-35.5) and 5.8 (95% CI 0.5-65.6) for salvage EBRT post-prostatectomy recurrence, and 3.2 (95% CI 0.7-14.0) and 3.9 (95% CI 0.3-44.1) for primary ADT (P = 0.558; P = 0.181), respectively. Comparing multimodal treatment and monotherapy confirmed the above trends. Local recurrence more typically occurred in pure dPC patients, mixed histology more frequently produced metastatic spread (29.6% relapse in total, P = 0.026). CONCLUSION Albeit some limitations affected the study, our findings support the role of local treatment to achieve better disease control and improve quality of life. Different behavior, with typical local growth in pure dPC, higher distant metastatization in the mixed form, might influence treatment response. Given its poor prognosis, we recommend multidisciplinary management of dPC.
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22
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Ranasinghe WKB, Brooks NA, Elsheshtawi MA, Davis JW, Bathala TK, Tang C, Troncoso P, Aparicio A, Tu SM, Pisters LL, Chapin BF. Patterns of metastases of prostatic ductal adenocarcinoma. Cancer 2020; 126:3667-3673. [PMID: 32453443 DOI: 10.1002/cncr.32957] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The current study was conducted to investigate the patterns of metastases in men with metastatic prostatic ductal adenocarcinoma (DAC) and recurrence patterns after therapy. METHODS All patients with a new diagnosis of DAC with de novo metastases and those with localized disease who developed metastases after treatment and were treated at the study institution from January 2005 to November 2018 were included. All patient and tumor characteristics and outcome data were collected. RESULTS A total of 164 patients (37.7%) had metastatic DAC, including 112 with de novo metastases and 52 who developed metastases after treatment. Men with de novo metastases were found to have a significantly higher median prostate-specific antigen level and International Society of Urological Pathology grade but a lower cT3 and/or T4 classification compared with those with metastases that developed after treatment (all P < .05). Approximately 87% of men with de novo metastases progressed despite multiple systemic therapies, 37.6% required intervention for the palliation of symptoms, and 10.1% responded to systemic therapy and underwent treatment of the primary tumor. Men with de novo metastatic DAC and those who developed metastases after treatment had multiple metastatic sites (including bone and viscera), with higher rates of lung metastases noted in the posttreatment group (23.2% vs 44.2%; P = .01). A total of 45 patients who were treated with curative intent developed metastases at a median of 22 months (range, 0.9-74.8 months) after treatment, at low prostate-specific antigen levels (median, 4.4 ng/mL [interquartile range, 1.7-11.1 ng/mL]). CONCLUSIONS The current study described the metastatic patterns of DAC in both patients with de novo metastatic disease and those who later progress to metastases. Men receiving treatment for DAC with curative intent require stringent long-term follow-up with imaging modalities, including chest imaging given the predilection toward lung metastases noted among these patients.
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Affiliation(s)
- Weranja K B Ranasinghe
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nathan A Brooks
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed A Elsheshtawi
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tharakeswara K Bathala
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Louis L Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Haller B, Yao HHI, Christidis D, Chee J, Bishop C. Clinical recurrence of prostatic ductal adenocarcinoma in the anterior urethra. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820921312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Britt Haller
- Department of Urology, Western Health, Australia
| | | | | | - Justin Chee
- Department of Urology, Western Health, Australia
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24
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Initial Diagnosis and Detection of Very Late Local Recurrence of a Ductal Prostate Cancer due to a Ureteral Stone. Case Rep Urol 2020; 2020:5392523. [PMID: 32148999 PMCID: PMC7053459 DOI: 10.1155/2020/5392523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 74-year-old patient in whom a ductal prostate cancer was incidentally endoscopically diagnosed in the course of ureteral stenting due to a left distal ureteral stone. The initial PSA was 0.8 μg/l and the digital rectal examination was not suspicious. A radical prostatectomy was performed, and the ensuing follow-up was unremarkable with no signs of recurrence. Fourteen years later, the patient presented with an obstructive pyelonephritis due to a left-sided ureteral stone requiring ureteral stenting. An exophytic tumor was seen in the lining of vesicourethral anastomosis and surgically excised after the pyelonephritis subsided. The histopathological and immunohistochemical analysis revealed a ductal cancer of the prostate consistent with a late local recurrence. Serum PSA was below the limit of detection. Re-staging performed by an MRI of the pelvis, thoracoabdominal CT scan, and gallium-68 PSMA-PET did not reveal any other signs of disease. The ensuing follow-up is planned with regular flexible cystoscopy and computed thoracoabdominopelvic CT scans.
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25
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Park CK, Shin SJ, Cho YA, Joo JW, Cho NH. HoxB13 expression in ductal type adenocarcinoma of prostate: clinicopathologic characteristics and its utility as potential diagnostic marker. Sci Rep 2019; 9:20205. [PMID: 31882852 PMCID: PMC6934792 DOI: 10.1038/s41598-019-56657-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/18/2019] [Indexed: 01/12/2023] Open
Abstract
The histologic criteria and selective biomarkers of prostate ductal type adenocarcinoma (DAC) are relatively unknown compared to that known about acinar type adenocarcinoma (AAC). It is known that genetic alteration in Hox13 gene is associated with carcinogenesis of prostate cancer. In this study, we investigated clinicopathologic characteristics of HoxB13 expression in prostate cancer and compared clinicopathologic profiles of DAC and AAC of prostate. After slide review, some morphological variants of DAC, equivalent to Gleason pattern 3 and 5 of AAC were identified. High level of HoxB13 expression was identified in 46.5% (46 out of 99 cases) and 39.2% (31 out of 79 cases) of cases that belong to the training set and test set, respectively. In the training set, high level of HoxB13 expression was significantly correlated with DAC (P < 0.001), higher Gleason score (P < 0.001), advanced pathologic T stage (P = 0.010), and occurrence of biochemical recurrence (BCR; P < 0.001). The test set confirmed that high level of HoxB13 expression was associated with DAC (P < 0.001), higher Gleason score (P = 0.001), advanced pathologic T stage (P < 0.001), and occurrence of BCR (P < 0.001). Our findings suggest that HoxB13 may be a useful diagnostic marker for detection of DAC and a prognostic marker for prediction of BCR.
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Affiliation(s)
- Cheol Keun Park
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Pathology, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Su-Jin Shin
- Department of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ah Cho
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Pathology and Translational genomics, Samsung medical center, Seoul, Republic of Korea
| | - Jin Woo Joo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Hoon Cho
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Iakymenko OA, Lugo I, Kwon D, Zhao W, Hayee A, Punnen S, Parekh DJ, Pollack A, Ritch CR, Gonzalgo ML, Stoyanova R, Jorda M, Kryvenko ON. Prostatic Ductal Adenocarcinoma Controlled for Cancer Grade and Tumor Volume Does Not Have an Independent Effect on Adverse Radical Prostatectomy Outcomes Compared to Usual Acinar Prostatic Adenocarcinoma. Urology 2019; 137:108-114. [PMID: 31711982 DOI: 10.1016/j.urology.2019.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study if prostatic ductal adenocarcinoma (PDA) controlled by Grade Group (GG), PSA, and tumor volume (TV) is an independent predictor of adverse radical prostatectomy (RP) outcomes. MATERIALS One-hundred and twenty-eight PDA and 1141 acinar continuous RPs were studied. Each tumor nodule (TN) was individually graded, staged, and its TV measured. Univariate analysis (UVA) identified features associated with lymph node metastasis (LN+), extraprostatic extension (EPE), positive surgical margins (SM+), and seminal vesicle invasion (SV+). We then assessed PDA effect on RP outcomes in a multivariate analysis (MVA). RESULTS In 127 cases PDA was present in 1 TN and no TN was pure PDA. One-hundred and twenty-three cases had PDA in TNs with highest grade, stage, and TV. Patients with PDA were older (65 vs 63 years, P < 0.001), had higher GG (P < 0.001), and LN+ (6.3% vs 2.7%, P = 0.049). Controlling these variables by GG eliminated statistical significance. Overall, there were 3249 separate TNs (129 PDA and 3120 acinar). In UVA, PDA predicted EPE (92/124 vs 517/3045), SV+ (28/1129 vs 116/3,120), and SM+ (51/129 vs 296/3120), all P < 0.001. In MVA, PDA lost its effect on EPE (OR = 0.88, P = 0.64), SM+ (OR = 0.86, P = 0.5), and SV+ (OR = 0.99, P = 0.98). CONCLUSION Controlled for grade and TV, PDA was not an independent predictor of adverse RP outcomes, but former 2 were. Hence, higher GG and TV associated with PDA TNs may be predictive of adverse RP outcomes rather than PDA by itself. These conclusions may be used in preoperative risk stratification and definitive therapy planning when PDA is identified on needle biopsy.
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Affiliation(s)
- Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Isabella Lugo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Amin Hayee
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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27
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Wu T, Zhao J, Liu Z, Shen P, Zhang M, Sun G, Liu J, Liao B, Chen J, Zhu S, Dai J, Wang Z, Zhang H, Zhao P, Zhang X, Zhu X, Ni Y, Chen N, Zeng H. Does ductal adenocarcinoma of the prostate (DA) have any prognostic impact on patients with de novo metastatic prostate cancer? Prostate 2019; 79:1673-1682. [PMID: 31433509 DOI: 10.1002/pros.23892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/22/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognostic value of ductal adenocarcinoma of the prostate (DA) in nonmetastatic prostate cancer (PCa) has been identified in many studies. However, it remains unknown whether DA is an adverse prognostic factor in metastatic PCa (mPCa). METHOD Data from 634 mPCa patients histopathologically documented with DA or/and acinar adenocarcinoma of the prostate in our center between 2012 and 2018 were retrospectively analyzed. Propensity score matching (PSM) was used to balance the baseline features. Data from the Surveillance, Epidemiology, and End Results (SEER) database were utilized to validate our findings. Castration-resistant PCa-free survival (CFS), overall survival (OS), and cancer-specific survival (CSS) were set as endpoints. RESULTS DA was confirmed in 35 of 634 (5.5%) patients. Among the DA-positive patients, 7 of 35 (20%) and 28 of 35 (80%) harbored high (DA ≥ 50%) and low (DA < 50%) DA components, respectively. DA was not associated with poorer median CFS (mCFS) or median OS (mOS) either before PSM (mCFS: 16.9 vs 18.4 month, P = .814; mOS: 42.0 vs 70.1 month, P = .796) or after PSM (mCFS: 16.9 vs 16.9 month, P = .949; mOS: 42.0 vs 79.9 month, P = .960). Likewise, in the SEER data, DA-positive patients (n = 15 153) shared similar median CSS (25.0 vs 28.0 month, P = .206) and OS (26.0 vs 35.0 month, P = .095) with DA-negative patients (n = 70). No prognostic difference was found between patients with high and low DA components. CONCLUSION We conducted the first study investigating the prognostic value of DA in de novo mPCa. DA was not associated with adverse clinical outcomes in mPCa patients. These findings are helpful for prognostic evaluation, treatment decision making and counseling in mPCa patients.
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Affiliation(s)
- Tao Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengni Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiandong Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Banghua Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhipeng Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Haoran Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xudong Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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28
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Au S, Villamil CF, Alaghehbandan R, Wang G. Prostatic ductal adenocarcinoma with cribriform architecture has worse prognostic features than non-cribriform-type. Ann Diagn Pathol 2019; 39:59-62. [PMID: 30772651 DOI: 10.1016/j.anndiagpath.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
Abstract
Prostatic ductal adenocarcinoma (PDA) is a rare histologic subtype of prostate cancer characterized by large glands lined with tall columnar pseudostratified epithelium. PDA has several architectural patterns, with papillary and cribriform being the most common. The cribriform pattern of acinar carcinoma has shown to be associated with a worse prognosis in terms of disease progression and disease-specific mortality. However, the significance of cribriform pattern in PDA is unknown. In this study, we sought to compare the adverse pathologic features between cribriform-type and non-cribriform-type PDA, and between PDA and acinar carcinoma with Gleason scores 8-10. We identified PDA cases diagnosed between 2008 and 2018 and 428 radical prostatectomy (RP) specimens containing Gleason 8-10 acinar carcinoma. The slides of all PDA cases were reviewed, and pathologic features were recorded. We found that the vast majority of PDA contained admixed acinar carcinoma, with a median percentage of the ductal component of 50% (range 5-100). 29% of PDA was graded as Grade Group 4 and 35.5% as Grade Group 5. At the time of RP, 45.2% of cases presented as pathologic stage T3a and 29% as T3b. Cribriform-type PDA demonstrated a significantly higher likelihood of extraprostatic extension (84% vs 33.3%, p = 0.01), seminal vesical invasion (36% vs 0%, p = 0.04), lymphovascular invasion (40% vs 0%, p = 0.03) and advanced pathologic stage (84% vs 33.3%, p = 0.01) compared to PDA without cribriform architecture. The proportion of stage ≥pT3 tumors in PDA was similar compared to that in Gleason 8-10 acinar carcinoma (74.2% vs 70.8%, p = 0.68).
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Affiliation(s)
- Sammy Au
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Carlos F Villamil
- Department of Pathology and Laboratory Medicine, BC Cancer Agency, Vancouver, BC, Canada.
| | - Reza Alaghehbandan
- Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Gang Wang
- Department of Pathology and Laboratory Medicine, BC Cancer Agency, Vancouver, BC, Canada.
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29
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Bergamin S, Eade T, Kneebone A, Kench J, Sved P, Biset JF, Hruby G. Ductal Carcinoma of the Prostate: An Uncommon Entity With Atypical Behaviour. Clin Oncol (R Coll Radiol) 2019; 31:108-114. [DOI: 10.1016/j.clon.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
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30
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31
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Lee TK, Ro JY. Spectrum of Cribriform Proliferations of the Prostate: From Benign to Malignant. Arch Pathol Lab Med 2018; 142:938-946. [DOI: 10.5858/arpa.2018-0005-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The presence of cribriform glands/ducts in the prostate can pose a diagnostic challenge. Cribriform glands/ducts include a spectrum of lesions, from benign to malignant, with vastly different clinical, prognostic, and treatment implications.
Objective.—
To highlight the diagnostic features of several entities with a common theme of cribriform architecture. We emphasize the importance of distinguishing among benign entities such as cribriform changes and premalignant to malignant entities such as high-grade prostatic intraepithelial neoplasia, atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, and invasive adenocarcinoma (acinar and ductal types). The diagnostic criteria, differential diagnosis, and clinical implications of these cribriform lesions are discussed.
Data Sources.—
Literature review of pertinent publications in PubMed up to calendar year 2017. Photomicrographs obtained from cases at the University of California at Irvine and authors' collections.
Conclusions.—
Although relatively uncommon compared with small acinar lesions (microacinar carcinoma and small gland carcinoma mimickers), large cribriform lesions are increasingly recognized and have become clinically and pathologically important. The spectrum of cribriform lesions includes benign, premalignant, and malignant lesions, and differentiating them can often be subtle and difficult. Intraductal carcinoma of the prostate in particular is independently associated with worse prognosis, and its presence in isolation should prompt definitive treatment. Patients with atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, or even focal cribriform pattern of invasive adenocarcinoma in biopsies would not be ideal candidates for active surveillance because of the high risk of adverse pathologic findings associated with these entities.
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Affiliation(s)
| | - Jae Y. Ro
- From the Department of Pathology and Urology, University of California Irvine, Orange (Dr Lee); and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weil Cornell Medical College, Houston, Texas (Dr Ro)
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32
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Abstract
The category of intraductal lesions of the prostate includes a range of primary prostatic and nonprostatic processes with wide variation in prognosis and recommended follow-up. Studies have shown that pathologists are uncomfortable with the diagnosis of these lesions and that the diagnostic reproducibility is low in this category. Despite the diagnostic difficulty, their accurate and reproducible diagnosis is critical for patient management. This review aims to highlight the diagnostic criteria, prognosis, and treatment implications of common intraductal lesions of the prostate. It focuses on the recognition of intraductal carcinoma of the prostate (IDC-P) in prostate needle biopsies and how to distinguish it from its common mimickers, including high-grade prostatic intraepithelial neoplasia, invasive cribriform prostatic adenocarcinoma, urothelial carcinoma extending into prostatic ducts, and prostatic ductal adenocarcinoma. IDC-P is independently associated with higher risk disease, and its identification in a needle biopsy, even in the absence of invasive carcinoma, should compel definitive treatment. Conversely, high-grade prostatic intraepithelial neoplasia has a much better prognosis and in limited quantities does not even warrant a repeat biopsy. IDC-P must be distinguished from urothelial carcinoma involving prostatic ducts, as recommended treatment varies markedly. Ductal adenocarcinoma may confuse the pathologist and clinician by overlapping terminology, and morphology may also mimic IDC-P on occasion. The use of ancillary testing with immunohistochemistry and molecular markers has also been reviewed.
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33
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Jang WS, Shin SJ, Yoon CY, Kim MS, Kang DH, Kang YJ, Jeong WS, Cho NH, Choi YD. Prognostic Significance of the Proportion of Ductal Component in Ductal Adenocarcinoma of the Prostate. J Urol 2017; 197:1048-1053. [DOI: 10.1016/j.juro.2016.11.104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Shin
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myung Soo Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyuk Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Jin Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jeong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Hoon Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Pathology (NHC), Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up.
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MESH Headings
- Carcinoma, Acinar Cell/chemistry
- Carcinoma, Acinar Cell/diagnosis
- Carcinoma, Acinar Cell/pathology
- Carcinoma, Ductal/chemistry
- Carcinoma, Ductal/diagnosis
- Carcinoma, Ductal/pathology
- Carcinoma, Transitional Cell/chemistry
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/pathology
- Diagnosis, Differential
- Humans
- Male
- Neoplasm Grading
- Prostatic Intraepithelial Neoplasia/chemistry
- Prostatic Intraepithelial Neoplasia/diagnosis
- Prostatic Intraepithelial Neoplasia/pathology
- Prostatic Neoplasms/chemically induced
- Prostatic Neoplasms/diagnosis
- Prostatic Neoplasms/pathology
- Tumor Burden
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Affiliation(s)
- Mukul K Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA.
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35
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Seipel AH, Delahunt B, Samaratunga H, Egevad L. Ductal adenocarcinoma of the prostate: histogenesis, biology and clinicopathological features. Pathology 2016; 48:398-405. [DOI: 10.1016/j.pathol.2016.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 04/10/2016] [Accepted: 04/10/2016] [Indexed: 12/20/2022]
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36
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Liu T, Wang Y, Zhou R, Li H, Cheng H, Zhang J. The update of prostatic ductal adenocarcinoma. Chin J Cancer Res 2016; 28:50-7. [PMID: 27041926 DOI: 10.3978/j.issn.1000-9604.2016.02.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Tantan Liu
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
| | - Yingmei Wang
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
| | - Ru Zhou
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
| | - Haiyang Li
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
| | - Hong Cheng
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
| | - Jing Zhang
- 1 State Key Laboratory of Tumor Biology, Department of Pathology, Xijing Hospital, Xi'an 710032, China ; 2 Cadet Brigade, The Fourth Military Medical University, Xi'an 710032, China
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37
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Packiam VT, Patel SG, Pariser JJ, Richards KA, Weiner AB, Paner GP, VanderWeele DJ, Zagaja GP, Eggener SE. Contemporary Population-Based Comparison of Localized Ductal Adenocarcinoma and High-Risk Acinar Adenocarcinoma of the Prostate. Urology 2015. [DOI: 10.1016/j.urology.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Magers M, Kunju LP, Wu A. Intraductal Carcinoma of the Prostate: Morphologic Features, Differential Diagnoses, Significance, and Reporting Practices. Arch Pathol Lab Med 2015; 139:1234-41. [DOI: 10.5858/arpa.2015-0206-ra] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The differential diagnosis for atypical cribriform lesions of the prostate has become increasingly complex and includes intraductal carcinoma of the prostate, high-grade prostatic intraepithelial neoplasia, and atypical intraductal proliferations. In this review, we summarize the morphologic and molecular features and significance of intraductal carcinoma of the prostate. We also summarize our institution's strategy for reporting and treatment recommendations for intraductal carcinoma of the prostate.
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Affiliation(s)
- Martin Magers
- From the Department of Pathology, University of Michigan Hospitals, Ann Arbor
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39
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Baig FA, Hamid A, Mirza T, Syed S. Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization. Oman Med J 2015; 30:162-6. [PMID: 26171121 DOI: 10.5001/omj.2015.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/21/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought to characterize the ductal and acinar subtype of prostate adenocarcinoma using hematoxylin and eosin (H&E) staining and an immunohistochemical antibody cocktail. We also investigated the clinical features, prostate-specific antigen (PSA) levels, and biological aggressiveness of these tumors. METHODS We utilized tumor bearing prostate biopsies, obtained between 2010 and 2014 from Dow Diagnostic Research and Reference Laboratory, to identify cases of prostatic ductal and acinar adenocarcinoma using routine H&E and immunohistochemical staining. The immunohistochemical antibody cocktail 34βE12/p63/AMACR was used for staining. The association of clinicopathological variables including patient's age at diagnosis, Gleason score, and PSA levels before surgery was retrospectively analyzed. RESULTS A total of 10 ductal and 140 non-ductal cases were identified. Ductal cases were predominantly high grade with advanced histopathological features (90%; p=0.030). Marked elevation in PSA level was also reported in most cases. No other significant statistical difference was observed. CONCLUSIONS Pathological and immunohistochemical examination could be used to characterize ductal and acinar adenocarcinoma of the prostate. Ductal adenocarcinoma of the prostate is a rare subtype of prostate carcinoma and is be more likely to present with advanced grade cancer suggesting that timely detection of the disease is vital.
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Affiliation(s)
- Faraz A Baig
- Department of Pathology, Ziauddin University, Karachi, Pakistan
| | - Amna Hamid
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Talat Mirza
- Department of Pathology, Dow University of Health Sciences, Karachi, Pakistan
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Seipel AH, Delahunt B, Samaratunga H, Amin M, Barton J, Berney DM, Billis A, Cheng L, Comperat E, Evans A, Fine SW, Grignon D, Humphrey PA, Magi-Galluzzi C, Montironi R, Sesterhenn I, Srigley JR, Trpkov K, van der Kwast T, Varma M, Zhou M, Ahmad A, Moss S, Egevad L. Diagnostic criteria for ductal adenocarcinoma of the prostate: interobserver variability among 20 expert uropathologists. Histopathology 2014; 65:216-27. [PMID: 24467262 DOI: 10.1111/his.12382] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/23/2014] [Indexed: 11/30/2022]
Abstract
AIMS Ductal adenocarcinoma of the prostate (DAC) is clinically important, because its behaviour may differ from that of acinar adenocarcinoma. Our aims were to investigate the interobserver variability of this diagnosis among experts in uropathology and to define diagnostic criteria. METHODS AND RESULTS Photomicrographs of 21 carcinomas with ductal features were distributed among 20 genitourinary pathologists from eight countries. DAC was diagnosed by 18 observers (mean 13.2 cases, range 6-19). In 11 (52%) cases, a 2/3 consensus was reached for a diagnosis of DAC, and in five (24%) there was consensus against. In DAC, the respondents reported papillary architecture (86%), stratification of nuclei (82%), high-grade nuclear features (54%), tall columnar epithelium (53%), elongated nuclei (52%), cribriform architecture (40%), and necrosis (7%). The most important diagnostic feature reported for DAC was papillary architecture (59%), whereas nuclear and cellular features were considered to be most important in only 2-11% of cases. The most common differential diagnoses were intraductal prostate cancer (52%), high-grade PIN (37%), and acinar adenocarcinoma (17%). The most common reason for not diagnosing DAC was lack of typical architecture (33%). CONCLUSIONS Papillary architecture was the most useful diagnostic feature of DAC, and nuclear and cellular features were considered to be less important.
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Affiliation(s)
- Amanda H Seipel
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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41
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Preneoplasia in the prostate gland with emphasis on high grade prostatic intraepithelial neoplasia. Pathology 2013; 45:251-63. [PMID: 23478231 DOI: 10.1097/pat.0b013e32835f6134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are a variety of morphological patterns and processes that have been implicated in the pathogenesis of prostate cancer. Prostatic intraepithelial neoplasia (PIN), inflammation with or without atrophy, and adenosis (atypical adenomatous hyperplasia) have all been given candidate status as precursor lesions of prostatic adenocarcinoma. Based on decades of research, high grade prostatic intraepithelial neoplasia (HPIN), a proliferative lesion of prostatic secretory cells, has emerged as the most likely morphological pre-invasive lesion involved in the evolution of many but not all prostatic adenocarcinomas. In this manuscript, we briefly discuss other proposed precursors of prostatic adenocarcinoma and then focus on the history, diagnostic criteria and morphology of HPIN. The incidence of HPIN and its relationship to prostate cancer is reviewed. The differential diagnosis of large glandular patterns in the prostate is discussed in depth. Finally, we summarise the recent clinicopathological studies evaluating the clinical significance of HPIN and discuss follow-up strategies in men diagnosed with HPIN.
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Stajno P, Kalinowski T, Ligaj M, Demkow T. An incidentally diagnosed prostatic ductal adenocarcinoma. Cent European J Urol 2013; 66:164-7. [PMID: 24579020 PMCID: PMC3936143 DOI: 10.5173/ceju.2013.02.art14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/22/2022] Open
Abstract
Ductal adenocarcinoma of the prostate was initially described in 1967 by Melicow and Patcher. It was given the erroneous name endometrioid carcinoma, however, further studies confirmed the prostatic origin of this tumor. Currently DAP is classified as a histological variant of prostatic carcinoma. Compared with "classic" acinar carcinoma of the prostate, DAP is a rare histological finding. It's prevalence in prostatectomy and biopsy specimens varies from less than 1% for pure ductal adenocarcinoma up to 5% for mixed DAP. Because of its typical periurethral location, the tumor usually manifests itself clinically with urinary obstruction, urinary urgency, urinary frequency and hematuria. DAP is associated with more aggressive natural history and worse prognosis than pure AA - patients presented at more advanced stage, with poorly differentiated and distant disease. DAP has a tendency to spread to regional lymph nodes, axial skeleton, and visceral organs. We report a case of a 90-year old man who presented to our clinic with acute urinary retention and gross hematuria. He underwent suprapubic transvesical adenomectomy to diminish the urinary obstruction. The pathological examination of the specimens revealed a dominant focus of DAP, which was located near the intraprostatic urethra and a coexisting, smaller component of "classic" acinar adenocarcinoma.
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Affiliation(s)
- Paweł Stajno
- Urooncology Department, Maria Skłodowska–Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Tomasz Kalinowski
- Urooncology Department, Maria Skłodowska–Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Marcin Ligaj
- Pathology Department, Maria Skłodowska–Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Tomasz Demkow
- Urooncology Department, Maria Skłodowska–Curie Memorial Cancer Hospital, Warsaw, Poland
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Jardel P, Debiais C, Godet J, Irani J, Fromont G. Ductal carcinoma of the prostate shows a different immunophenotype from high grade acinar cancer. Histopathology 2013; 63:57-63. [DOI: 10.1111/his.12129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Celine Debiais
- Department of Pathology; CHU/Université de Poitiers; Poitiers; France
| | - Julie Godet
- Department of Pathology; CHU/Université de Poitiers; Poitiers; France
| | - Jacques Irani
- Department of Urology; CHU/Université de Poitiers; Poitiers; France
| | - Gaelle Fromont
- Department of Pathology; CHU/Université de Poitiers; Poitiers; France
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Histopathological features of ductal adenocarcinoma of the prostate in 1,051 radical prostatectomy specimens. Virchows Arch 2013; 462:429-36. [PMID: 23443941 DOI: 10.1007/s00428-013-1385-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/03/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Abstract
Ductal adenocarcinoma (DAC) of the prostate is thought to have worse prognosis than prostatic acinar carcinoma (PAC). We aimed to evaluate the prognostic significance of histopathological patterns of DAC. A series of 1,051 radical prostatectomy specimens from Karolinska University Hospital 1998-2005 was reviewed. A ductal component was classified as classical DAC (DACC) if it had columnar, pseudostratified epithelium, elongated nuclei, and papillary, glandular, or cribriform architecture; borderline DAC (DACB) if it lacked elongated nuclei or classical architecture; and prostatic adenocarcinoma with ductal features (PCDF) if stratified high-grade nuclei were found. DACC, DACB, and PCDF were seen in 2.6, 4.0, and 1.6 % of the cases. DAC was usually mixed with PAC and constituted 10-100 % (mean 40 %) of the main tumor. Location was periurethral, peripheral, or both in 69.8, 3.5, and 26.7 %. Necrosis was seen in 31.3 %, stromal invasion of DAC in 52.3 %, and intraductal spread in 91.9 %. In DACC/DACB and PAC, extraprostatic extension was seen in 66.7 and 42.4 % (p < 0.001) and seminal vesicle invasion in 13.0 and 5.0 % (p = 0.0045). DACC, DACB, and PCDF had a hazard ratio for biochemical recurrence of 1.5 (0.7-2.8), 1.4 (0.8-2.6) and 1.2 (0.5-2.7). When PCDF was excluded from DAC, hazard ratio was 1.4 (95 % CI 0.9-2.3, p = 0.12). Location, % DAC, necrosis, stromal invasion, or Gleason score were not predictive of recurrence. This suggests that DACC and DACB are more aggressive than average PAC, while cancers with acinar architecture and pseudostratified high-grade nuclei should not be included in DAC.
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45
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Clouston D, Bolton D. In situand intraductal epithelial proliferations of prostate: definitions and treatment implications. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11612.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Damien Bolton
- Department of Urology; Austin Hospital; Melbourne; Victoria; Australia
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Variants and unusual patterns of prostate cancer: clinicopathologic and differential diagnostic considerations. Adv Anat Pathol 2012; 19:204-16. [PMID: 22692283 DOI: 10.1097/pap.0b013e31825c6b92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Beyond the typical acinar morphology observed in the majority of prostatic adenocarcinomas, a spectrum of morphologic variants and prostate cancer subtypes exists. These unusual entities may be classified as: (1) cancer morphologies arising by divergent differentiation of prostatic ductal, acinar, or basal cells and associated with unique clinical features and/or therapeutic approaches, and (2) histologies occurring in the context of usual prostatic adenocarcinoma that may result in diagnostic misinterpretation or difficulties in Gleason grade assignment, especially in limited samples. This article details a number of variants, with emphasis on diagnostic criteria, differential diagnoses, and clinical significance.
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Tarján M, Chen HH, Tot T, Wu W, Lenngren A, Dean PB, Tabár L. Improved differentiation between ductal and acinar prostate cancer using three-dimensional histology and biomarkers. ACTA ACUST UNITED AC 2012; 46:258-66. [PMID: 22519924 DOI: 10.3109/00365599.2012.675586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to refine the methodology for discriminating the ductal (DAP) and acinar adenocarcinomas (AAP) of the prostate and confirm that prostate carcinoma of ductal origin is a more aggressive subtype. MATERIAL AND METHODS A retrospective analysis of 110 consecutive radical prostatectomy cases operated on between 2000 and 2006 and worked up using large-format "two-dimensional" (2D; 4 μm thick) and "three-dimensional" (3D; 1500 μm thick) histology sections was carried out, with an average follow-up of 5.1 years. The same material was also analysed for selected biomarkers in tissue microarray blocks. The most discriminatory biomarkers were then tested on preoperative core biopsy specimens from 24 of these patients. RESULTS 3D histology classified 97/110 (88%) cases of AAP and 13/110 (12%) DAP, which was then confirmed in 2D specimens. The DAP cases had a significantly greater frequency of pT3a and more advanced cancers, > 20 mm tumour focus, high-grade prostatic intraepithelial neoplasia, Gleason score ≥ 7, positive margin, extracapsular extension, vascular invasion, seminal vesicle infiltration, biochemical/local recurrence, regional lymph-node metastases and distant metastases. Three biomarkers in combination (chromogranin A, epidermal growth factor receptor and p53] distinguished DAP from AAP with an accuracy of 94% (area under the curve 0.94, 95% confidence interval 0.88-0.99). The same high accuracy was achieved using these three biomarkers on the preoperative specimens. CONCLUSIONS Both 3D histology and the three selected biomarkers can help in accurately distinguishing DAP from AAP. The clear-cut distinction of two forms of prostate cancers by the approach advocated in this paper would allow AAP patients to undergo less radical treatment and would segregate DAP patients into a subset requiring more effective treatment regimens.
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Affiliation(s)
- Miklós Tarján
- Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
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48
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Tarján M, Lenngren A, Hellberg D, Tot T. Immunohistochemical verification of ductal differentiation in prostate cancer. APMIS 2012; 120:510-8. [PMID: 22583364 DOI: 10.1111/j.1600-0463.2011.02862.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent studies have shown that patients with prostate carcinomas exhibiting ductal differentiation have an unfavourable prognosis compared with those with purely acinar adenocarcinomas. We studied the expression of nine immunohistochemical markers to evaluate their value in delineating carcinomas with and without ductal differentiation. Thirteen tumours showing cellular characteristics and growth patterns typical of ductal differentiation were identified among 110 analysed prostatectomy specimens. The levels of cytoplasmic expression of chromogranine A (69% vs 19%, p = 0.0003) and nuclear expression of p53 (76% vs 12%, p < 0.0001) as well as nuclear expression of Ki-67 (69% vs 26%, p = 0.0047) in the tumour cells, were found to be statistically significantly different in the two tumour categories. Assessment of chromogranine A, p53 and Ki-67 in prostate carcinoma may serve as useful adjunctive diagnostic tools for delineating more aggressive prostate cancer cases exhibiting ductal differentiation.
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Affiliation(s)
- Miklós Tarján
- Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
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Meeks JJ, Zhao LC, Cashy J, Kundu S. Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program. BJU Int 2011; 109:831-4. [PMID: 21883856 DOI: 10.1111/j.1464-410x.2011.10520.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers. PATIENTS AND METHODS From the SEER registry, 693 men with ductal PCa were identified from 1970. The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types. RESULTS The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable. Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa). Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures. Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa. Comparing PCa-specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa. CONCLUSIONS Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa-specific mortality similar to Gleason 4 + 4 acinar PCa. Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.
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Affiliation(s)
- Joshua J Meeks
- Northwestern University, Department of Urology, Chicago, IL, USA
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