The clinical outcome of prostate ductal adenocarcinoma: a multicentre matched cohort comparative study

Abstract

Objective:

Prostate Ductal Adenocarcinoma(PDA) is a rare variant of prostate cancer(PCa). There are conflicting reports regarding its oncological outcome and prognosis. To date, there is no consensus on what is the optimal treatment.

Patients and Methods:

All patients diagnosed with PDA in three institutions from London(UK), Hong Kong and Kingston(Jamaica) during 2005–2015 were included. Treatment included radical surgery, radical radiotherapy or hormone manipulation. Patients who were diagnosed with >=Gleason8 prostate acinar adenocarcinoma(PAA) served as control groups.

Results:

Of 9812 patients diagnosed with PCa, 157 (1.8%) had PDA; 958 had PAA. PSA at presentation was lower for PDA. 346 (247‐PAA,99‐PDA) had radical prostatectomy; 314 (295‐PAA,19‐PDA) had radical radiotherapy; 449 (416‐PAA,33‐PDA) had hormone treatment.

In surgery group, positive margin were 51%(PDA) vs 54%(PAA), p = 0.13. 57%(PDA) vs 46%(PAA) developed biochemical recurrence. 14%(PDA) vs 5.3%(PAA), p = 0.08 developed distant metastasis and 4.5%(PDA) vs 5.3%(PAA) have died. In radiotherapy group,16%(PDA) vs 22%(PAA) had biochemical recurrence, 16%(PDA) vs 9%(PAA), p = 0.01 developed distant metastasis, 17%(PDA) vs 18%(PAA), p = 0.76 have died. In hormone group, 71%(PDA) vs 47%(PAA) developed metastasis at 32 months; 71%(PDA) vs 45%(PAA) have died. Mean follow‐up for all groups is 71 months.

Conclusion:

PDA patients had higher risk of metastasis compared to the acinar group regardless of treatment offered. Early adjuvant treatment may be required in prostate ductal cancer.