The rising incidence of ductal adenocarcinoma and intraductal carcinoma of the prostate: Diagnostic accuracy of biopsy, MRI-visibility, and outcomes

ElsevierVolume 41, Issue 1, January 2023, Pages 48.e11-48.e18Urologic Oncology: Seminars and Original InvestigationsAuthor links open overlay panelHighlight•

Patients with ductal adenocarcinoma and/or intraductal carcinoma of the prostate have worse pathologic features on radical prostatectomy.

Findings of ductal adenocarcinoma and/or intraductal carcinoma of the prostate on final surgical pathology is associated with a worse biochemical recurrence.

Prostate biopsy has a low sensitivity for the diagnosis of ductal adenocarcinoma and intraductal carcinoma of the prostate.

There were no significant differences in MRI findings between patients with ductal adenocarcinoma and/or intraductal carcinoma of the prostate and those with pure acinar adenocarcinoma.

AbstractIntroduction

Ductal adenocarcinoma (DA) and intraductal carcinoma (IDC) of the prostate are associated with higher stage disease at radical prostatectomy (RP). We evaluated diagnostic accuracy of biopsy, MRI-visibility, and outcomes for patients undergoing RP with DA/IDC histology compared to pure acinar adenocarcinoma (AA) of the prostate.

Materials and Methods

A retrospective cohort study of men receiving RP between 2014 and 2021 revealing AA, DA, or IDC on final pathology was conducted. Multivariable logistic regression and Cox proportional hazards regression models were employed.

Results

A total of 609 patients were included with 103 found to have DA/IDC. Patients with DA/IDC were older and had higher PSA, biopsy grade group (GG), RP GG, and other pathologic findings (extraprostatic extension, lymphovascular invasion, perineural invasion, pN stage) compared to AA patients (all P < 0.05). On multivariable analysis, higher age, RP GG, and pT3a were associated with DA/IDC on RP (all P < 0.05). Sensitivity and specificity of biopsy compared to RP for diagnosis of DA/IDC was 29.1% (16.7% DA, 27.8% IDC) and 96.6% (99.3% DA, 96.6% IDC), respectively. In a subset of 281 men receiving MRI, PI-RADS distribution was similar for patients with DA/IDC vs. AA (90.7% vs. 80.7% with PI-RADS 4–5 lesions, P = 0.23) with slightly higher biopsy sensitivity (41.9%). DA/IDC was associated with worse BCR (HR = 1.77, P = 0.02) but not biopsy DA/IDC (P = 0.90).

Conclusions

Sensitivity of prostate biopsy was low for detection of DA/IDC histology at RP. Patients with DA/IDC histology had unfavorable pathologic features at RP and worse BCR. Of patients with DA/IDC at RP, 90.7% were categorized as PI-RADS 4 to 5 on preoperative MRI.

Keywords

Prostate cancer

Ductal adenocarcinoma

Intraductal adenocarcinoma

AbbreviationsBCR

biochemical recurrence

MRI

magnetic resonance imaging

NPV

negative predictive value

PPV

positive predictive value

PI-RADS

prostate imaging-reporting and data system

PSA

prostate specific antigen

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