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



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.


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.


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).


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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Author information




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.

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Correspondence to Lilia Bardoscia.

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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).

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