Non-metastatic ductal adenocarcinoma of the prostate: pattern of care from an uro-oncology multidisciplinary group

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Morgan TM, Welty CJ, Vakar-Lopez F, Lin DW, Wright JL (2010) Ductal adenocarcinoma of the prostate: increased mortality risk and decreased PSA secretion. J Urol 184(6):2303–2307

    CAS  Article  Google Scholar 

  2. 2.

    Melicow MM, Pachtr MR (1967) Endometrial carcinoma of prostatic Utricle (uterus masculinus). Cancer 20:1715–1722

    CAS  Article  Google Scholar 

  3. 3.

    Vale JA, Patel A, Ball AJ, Hendry WF, Chappeli ME, Fisher C (1992) Endometriold carcinoma of the prostate: a misnomer? J Royal Soc Med 85:394–396

    CAS  Google Scholar 

  4. 4.

    Meeks JJ, Zhao LC, Cashy J, Kundu S (2012) 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 109(6):831–834 (Epub 2011 Aug 24)

    Article  Google Scholar 

  5. 5.

    Bostwick DG, Kindrachuk RW, Rouse RV (1985) Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings. Am J Surg Pathol 9:595–609

    CAS  Article  Google Scholar 

  6. 6.

    Christensen WN, Steinberg G, Walsh PC, Epstein JI (1991) Prostatic duct adenocarcinoma findings at radical prostatectomy. Cancer 67(8):2118–2124

    CAS  Article  Google Scholar 

  7. 7.

    Brinker DA, Potter SR, Epstein JI (1999) Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol 23:1471–1479

    CAS  Article  Google Scholar 

  8. 8.

    Lemberger RJ, Bishop MC, Bates CP et al (1984) Carcinoma of the prostate of ductal origin. Br J Urol 56:706–709

    CAS  Article  Google Scholar 

  9. 9.

    McNeal JE, Reese JH, Redwine EA et al (1986) Cribriform adenocarcinoma of the prostate. Cancer 58:1714–1719

    CAS  Article  Google Scholar 

  10. 10.

    Rubin MA, de La Taille A, Bagiella E et al (1998) Cribriform carcinoma of the prostate and cribriform prostatic intraepithelial neoplasia: Incidence and clinical implications. Am J Surg Pathol 22:840–848

    CAS  Article  Google Scholar 

  11. 11.

    Orihuela E, Green JM (2008) Ductal prostate cancer: contemporary management and outcomes. Urol Oncol 26:368–371

    Article  Google Scholar 

  12. 12.

    Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251

    CAS  Article  Google Scholar 

  13. 13.

    Sobin HL, Gospodarowicz MK, Wittekind C (eds) (2009) TNM classification of malignant tumours, 7th edn. UICC - International Union Against Cancer

  14. 14.

    Buyyounouski MK, Hanlon AL, Eisenberg DF, Horwitz EM, Feigenberg SJ, Uzzo RG, Pollack A (2005) Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. Int J Radiat Oncol Biol Phys 63(5):1455–1462

    Article  Google Scholar 

  15. 15.

    Gray RJ (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154

    Article  Google Scholar 

  16. 16.

    Austin PC, Lee DS, Fine JP (2016) Introduction to the analysis of survival data in the presence of competing risks. Circulation 133(6):601–609

    Article  Google Scholar 

  17. 17.

    Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  18. 18.

    D’Amico AV, Whittington R, Malkowicz B et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974

    Article  Google Scholar 

  19. 19.

    Seipel AH, Delahunt B, Samaratunga H, Egevad L (2016) Ductal adenocarcinoma of the prostate: histogenesis, biology and clinicopathological features. Pathology 48(5):398–405

    Article  Google Scholar 

  20. 20.

    Bronkema C, Arora S, Sood A, Dalela D, Keeley J, Borchert A, Baumgarten L, Rogers CG, Peabody JO, Menon M, Abdollah F (2020) Rare histological variants of prostate adenocarcinoma: a national cancer database analysis. J Urol. https://doi.org/10.1097/JU.0000000000001011 (Online ahead of print)

    Article  PubMed  Google Scholar 

  21. 21.

    Wai Man Kan R, Fai Kan C, Hon Ming Wong J, Kam Fung FuK, Fai Ng C, Wai Hee Chan S (2014) Ductal adenocarcinoma of the prostate: a Hong Kong case series. Int Urol Nephrol 46:2133–2137

    Article  Google Scholar 

  22. 22.

    Eade TN, Al-Saleem T, Horwitz EN, Buyyounouski MK, Chen DYT, Pollack A (2007) Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate. Cancer 109(10):2011–2015

    Article  Google Scholar 

  23. 23.

    Epstein JI (2010) Prostatic ductal adenocarcinoma: a mini review. Med Princ Pract 19:82–85

    Article  Google Scholar 

  24. 24.

    Samaratunga H, Duffy D, Yaxley J, Delahunt B (2010) Any proportion of ductal adenocarcinoma in radical prostatectomy specimens predicts extraprostatic extension. Hum Pathol 41(2):281–285 (Epub 2009 Dec 11)

    Article  Google Scholar 

  25. 25.

    Epstein JI, Allsbrook WC, Amin MB et al (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostate cancer. Am J Surg Pathol 29:1228–1242

    Article  Google Scholar 

  26. 26.

    Tu SM, Lopey A, Leibovici D, Bilen MA, Evliyaoglu F, Asparicio A, Guo CC, Kuban DA, Johnson MM, Pisters LL (2009) Ductal adenocarcinoma of the prostate: clinical features and implications after local therapy. Cancer 115(13):2872–2880

    Article  Google Scholar 

  27. 27.

    Schweizer MT, Antonarakis ES, Bismar TA, Guedes LB, Cheng HH, Tretiakova MS, Vakar-Lopez F, Klemfuss N, Konnick EQ, Mostaghel EA, Hsieh AC, Nelson PS, Yu EY, Montgomery RB, True LD, Epstein JI, Lotan TL, Pritchard CC (2019) Genomic characterization of prostatic ductal adenocarcinoma identifies a high prevalence of DNA repair gene mutations. JCO Precis Oncol. https://doi.org/10.1200/PO.18.00327 (Epub 2019 Apr 18)

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Gillessen S, Attard G, Beer TM, Beltran H, Bossi A et al (2018) Management of patients with advanced prostate cancer: the report of the advanced prostate cancer consensus conference APCCC 2017. Eur Urol 73(2):178–211

    Article  Google Scholar 

  29. 29.

    Kim A, Kwon T, You D, Gab Jeong I, Go H, Mee Cho Y, Hyuk Hong J, Ahn H, Kim C-S (2015) Clinicopathological features of prostate ductal carcinoma: matching analysis and comparison with prostate acinar carcinoma. J Korean Med Sci 30:385–389

    Article  Google Scholar 

  30. 30.

    Knipper S, Preisser F, Mazzone E, Mistretta FA, Tian Z, Briganti A, Zorn KC, Saad F, Tilki D, Graefen M, Karakiewicz PI (2019) Contemporary comparison of clinicopathologic characteristics and survival outcomes of prostate ductal carcinoma and acinar adenocarcinoma: a population-based study. Clin Genitourin Cancer 17:231–237. https://doi.org/10.1016/j.clgc.2019.04.009

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

LB: project development, data management, data analysis, manuscript writing, LT: project development, data analysis, manuscript editing, MS: data analysis, SF: data collection and manuscript writing, PB: data interpretation, ADV: data interpretation, AV: manuscript writing, DT: data collection, MB: data interpretation and manuscript editing, FV: manuscript editing, CS: manuscript editing, AB: manuscript editing, SMM: manuscript editing, and AA: data integrity check, data analysis accuracy check, and manuscript editing.

Corresponding author

Correspondence to Lilia Bardoscia.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bardoscia, L., Triggiani, L., Sandri, M. et al. Non-metastatic ductal adenocarcinoma of the prostate: pattern of care from an uro-oncology multidisciplinary group. World J Urol (2020). https://doi.org/10.1007/s00345-020-03315-8

Download citation

Keywords

  • Ductal prostate cancer
  • Local treatment
  • Multidisciplinary tumor board
  • External beam radiotherapy
  • Radical prostatectomy
  • Androgen deprivation therapy