Ductal adenocarcinoma of the prostate diagnosed on transurethral biopsy or resection is not always indicative of aggressive disease: Implications for clinical management

Hakan Aydin, Jun Zhang, Hemamali Samaratunga, Nelly Tan, Cristina Magi-Galluzzi, Eric Klein, J. Stephen Jones, Ming Zhou

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Study Type - Prognosis (case series) Level of Evidence 4 Objective To report the clinicopathological characteristics of 23 cases of ductal adenocarcinoma of the prostate (DCP) and discuss the implications for clinical management, as DCP is considered an aggressive subtype of prostate adenocarcinoma (PA). Patients and Methods The presence of DCP in transrectal ultrasonography-guided prostate biopsy (TRUSB) is associated with adverse pathological findings at radical prostatectomy (RP) and clinical outcomes, and the significance of detecting DCP initially in transurethral biopsy (UB) or transurethral resection (TURP) in the present era of screening with prostate-specific antigen (PSA) is unclear. The study included 23 cases of pure DCP without acinar PA diagnosed on UB or TURP. Demographic information, serum PSA level, follow-up surgical procedures (RP, TURP or TRUSB) and outcome data were collected. Results The mean age of the men was 67.5 years and the mean PSA level before the procedure was 12.5 ng/mL; 14 cases were detected on UB and nine were diagnosed on TURP. The mean (range) follow-up was 4 (1-23) months after the initial procedure. In all, 21 (89%) patients had DCP or PA in follow-up procedures. Two (11%) patients had no residual cancer, one on RP and the other on two repeat TURPs. DCP or PA was found in 12 RP cases; four patients had Gleason score 7 PA, three of which were organ-confined, and eight had Gleason score ≥8 PA. Extraprostatic extension, seminal vesicle invasion and regional lymph node metastasis were present in seven, six and two cases, respectively. ConclusionS Most DCP diagnosed on UB or TURP in this contemporary series was associated with aggressive PA, but a subset presented as a small periurethral tumour with no concomitant acinar PA, and was eradicated by the initial biopsy/TURP alone. We recommend that patients with a diagnosis of DCP on UB or TURP undergo follow-up TURP and TRUSB before radical surgery is offered.

Original languageEnglish (US)
Pages (from-to)476-480
Number of pages5
JournalBJU International
Volume105
Issue number4
DOIs
StatePublished - Feb 1 2010

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Prostate
Adenocarcinoma
Biopsy
Transurethral Resection of Prostate
Prostatectomy
Prostate-Specific Antigen
Ultrasonography
Neoplasm Grading
Seminal Vesicles
Residual Neoplasm

Keywords

  • Ductal adenocarcinoma of the prostate
  • Outcomes
  • Pathology
  • Prostate carcinoma
  • Transurethral biopsy

ASJC Scopus subject areas

  • Urology

Cite this

Ductal adenocarcinoma of the prostate diagnosed on transurethral biopsy or resection is not always indicative of aggressive disease : Implications for clinical management. / Aydin, Hakan; Zhang, Jun; Samaratunga, Hemamali; Tan, Nelly; Magi-Galluzzi, Cristina; Klein, Eric; Jones, J. Stephen; Zhou, Ming.

In: BJU International, Vol. 105, No. 4, 01.02.2010, p. 476-480.

Research output: Contribution to journalArticle

Aydin, Hakan ; Zhang, Jun ; Samaratunga, Hemamali ; Tan, Nelly ; Magi-Galluzzi, Cristina ; Klein, Eric ; Jones, J. Stephen ; Zhou, Ming. / Ductal adenocarcinoma of the prostate diagnosed on transurethral biopsy or resection is not always indicative of aggressive disease : Implications for clinical management. In: BJU International. 2010 ; Vol. 105, No. 4. pp. 476-480.
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AU - Klein, Eric

AU - Jones, J. Stephen

AU - Zhou, Ming

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N2 - Study Type - Prognosis (case series) Level of Evidence 4 Objective To report the clinicopathological characteristics of 23 cases of ductal adenocarcinoma of the prostate (DCP) and discuss the implications for clinical management, as DCP is considered an aggressive subtype of prostate adenocarcinoma (PA). Patients and Methods The presence of DCP in transrectal ultrasonography-guided prostate biopsy (TRUSB) is associated with adverse pathological findings at radical prostatectomy (RP) and clinical outcomes, and the significance of detecting DCP initially in transurethral biopsy (UB) or transurethral resection (TURP) in the present era of screening with prostate-specific antigen (PSA) is unclear. The study included 23 cases of pure DCP without acinar PA diagnosed on UB or TURP. Demographic information, serum PSA level, follow-up surgical procedures (RP, TURP or TRUSB) and outcome data were collected. Results The mean age of the men was 67.5 years and the mean PSA level before the procedure was 12.5 ng/mL; 14 cases were detected on UB and nine were diagnosed on TURP. The mean (range) follow-up was 4 (1-23) months after the initial procedure. In all, 21 (89%) patients had DCP or PA in follow-up procedures. Two (11%) patients had no residual cancer, one on RP and the other on two repeat TURPs. DCP or PA was found in 12 RP cases; four patients had Gleason score 7 PA, three of which were organ-confined, and eight had Gleason score ≥8 PA. Extraprostatic extension, seminal vesicle invasion and regional lymph node metastasis were present in seven, six and two cases, respectively. ConclusionS Most DCP diagnosed on UB or TURP in this contemporary series was associated with aggressive PA, but a subset presented as a small periurethral tumour with no concomitant acinar PA, and was eradicated by the initial biopsy/TURP alone. We recommend that patients with a diagnosis of DCP on UB or TURP undergo follow-up TURP and TRUSB before radical surgery is offered.

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