Prognostic Significance of the Proportion of Ductal Component in Ductal Adenocarcinoma of the Prostate

No AccessJournal of UrologyAdult Urology1 Apr 2017Prognostic Significance of the Proportion of Ductal Component in Ductal Adenocarcinoma of the Prostate Won Sik Jang, Su-Jin Shin, Cheol Yong Yoon, Myung Soo Kim, Dong Hyuk Kang, Yong Jin Kang, Won Sik Jeong, Nam Hoon Cho, and Young Deuk Choi Won Sik JangWon Sik Jang Equal study contribution. More articles by this author , Su-Jin ShinSu-Jin Shin More articles by this author , Cheol Yong YoonCheol Yong Yoon More articles by this author , Myung Soo KimMyung Soo Kim More articles by this author , Dong Hyuk KangDong Hyuk Kang More articles by this author , Yong Jin KangYong Jin Kang More articles by this author , Won Sik JeongWon Sik Jeong More articles by this author , Nam Hoon ChoNam Hoon Cho More articles by this author , and Young Deuk ChoiYoung Deuk Choi Equal study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.11.104AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In prostate cancer ductal adenocarcinoma is mixed with the usual acinar adenocarcinoma. However, to our knowledge whether the proportion of the ductal component affects oncologic outcomes is currently unknown. We investigated whether the proportion of the ductal component predicts oncologic outcomes in ductal adenocarcinoma. Materials and Methods: We retrospectively reviewed clinical data on 3,038 patients with prostate cancer who underwent radical prostatectomy at our institution between 2005 and 2014. We excluded patients who received neoadjuvant or adjuvant treatment. Patients were stratified based on the proportion of the ductal component. We compared the probability of biochemical recurrence between groups and investigated how the proportion of the ductal component influences biochemical recurrence using Kaplan-Meier estimates and Cox regression models, respectively. Results: Of 2,648 patients 101 (3.8%) had ductal adenocarcinoma and 2,547 (96.2%) had acinar adenocarcinoma. Freedom from biochemical recurrence in patients with ductal adenocarcinoma was significantly lower than in those with acinar adenocarcinoma (p <0.001). When ductal cases were stratified by the proportion of the ductal component, freedom from biochemical recurrence in the high ductal component group was significantly lower compared to that in the low ductal component group (30% or greater vs less than 30%, p = 0.023). On univariate and multivariate Cox regression analyses, a high ductal component was a significant predictor of biochemical recurrence (p <0.001). Conclusions: The prognosis for ductal adenocarcinoma can be stratified by the proportion of the ductal component. This marker could potentially be used as a surrogate for poor prognosis or as a determinant for adjuvant therapy. References 1 : Adenocarcinoma of the prostate invading the seminal vesicle: prognostic stratification based on pathologic parameters. Urology2000; 56: 283. Google Scholar 2 : Pathologic stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma. Am J Surg Pathol2011; 35: 615. Google Scholar 3 : Endometrial carcinoma of proxtatic utricle (uterus masculinus). Cancer1967; 20: 1715. Google Scholar 4 : Prostatic duct adenocarcinoma. Findings at radical prostatectomy. Cancer1991; 67: 2118. Google Scholar 5 : Ductal adenocarcinoma of the prostate diagnosed on transurethral biopsy or resection is not always indicative of aggressive disease: implications for clinical management. BJU Int2010; 105: 476. Google Scholar 6 : Does prostatic ductal adenocarcinoma exist?. Am J Surg Pathol1999; 23: 781. Google Scholar 7 : Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings. Am J Surg Pathol1985; 9: 595. Google Scholar 8 : Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol1999; 23: 1471. Google Scholar 9 : AJCC Cancer Staging Manual, 7th ed. New York: Springer2010. Google Scholar 10 : Prognostic impact of time to undetectable prostate-specific antigen in patients with positive surgical margins following radical prostatectomy. Ann Surg Oncol2015; 22: 693. Google Scholar 11 : The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol2005; 29: 1228. Google Scholar 12 : Current perspectives on the Gleason grading of prostate cancer. Arch Pathol Lab Med2009; 133: 1810. Google Scholar 13 : Rapid microwave-stimulated fixation of entire prostatectomy specimens. Biomed-II MPC Study Group. J Pathol1997; 183: 369. Google Scholar 14 : Intraductal carcinoma of the prostate on needle biopsy: histologic features and clinical significance. Mod Pathol2006; 19: 1528. Google Scholar 15 : High-grade prostatic intraepithelial neoplasialike ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol2008; 32: 1060. Google Scholar 16 : An application of changepoint methods in studying the effect of age on survival in breast cancer. Computational Statistics Data Analysis1999; 30: 253. Google Scholar 17 : Classical and Modern Regression with Applications, 2nd ed. Boston: PWS-KENT1990. p viii. Google Scholar 18 : Prostatic adenocarcinoma of ductal origin. J Urol1979; 121: 303. Link, Google Scholar 19 : Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate. Cancer2007; 109: 2011. Google Scholar 20 : The update of prostatic ductal adenocarcinoma. Chin J Cancer Res2016; 28: 50. Google Scholar 21 : Endometrial tumors and/or associated carcinomas of prostate. Urology1975; 6: 372. Google Scholar 22 : Immunohistochemical profile of ductal adenocarcinoma of the prostate. Virchows Arch2014; 465: 559. Google Scholar 23 : Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol2010; 184: 2303. Link, Google Scholar 24 : Clinicopathological features of prostate ductal carcinoma: matching analysis and comparison with prostate acinar carcinoma. J Korean Med Sci2015; 30: 385. Google Scholar 25 : Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program. BJU Int2012; 109: 831. Google Scholar 26 : Any proportion of ductal adenocarcinoma in radical prostatectomy specimens predicts extraprostatic extension. Hum Pathol2010; 41: 281. Google Scholar 27 : Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol2006; 24: 3973. Google Scholar 28 : Adverse pathologic features at radical prostatectomy: effect of preoperative risk on oncologic outcomes. Eur Urol2016; 69: 143. Google Scholar 29 : Natural history of early, localized prostate cancer. JAMA2004; 291: 2713. Google Scholar 30 : Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA2005; 294: 433. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 197Issue 4April 2017Page: 1048-1053 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsprostatectomylocalcarcinomaductalprognosisneoplasm recurrenceprostatic neoplasmsMetricsAuthor Information Won Sik Jang Equal study contribution. More articles by this author Su-Jin Shin More articles by this author Cheol Yong Yoon More articles by this author Myung Soo Kim More articles by this author Dong Hyuk Kang More articles by this author Yong Jin Kang More articles by this author Won Sik Jeong More articles by this author Nam Hoon Cho More articles by this author Young Deuk Choi Equal study contribution. More articles by this author Expand All Advertisement PDF downloadLoading ...