Ductal adenocarcinoma of the prostate: A systematic review and meta‐analysis of incidence, presentation, prognosis, and management
Context Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome. Objectives To systematically interrogate the literature to clarify the epidem...
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| Published in: | BJUI compass Vol. 2; no. 1; pp. 13 - 23 |
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| Main Authors: | , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
John Wiley & Sons, Inc
01.01.2021
John Wiley and Sons Inc |
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| ISSN: | 2688-4526, 2688-4526 |
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| Abstract | Context
Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome.
Objectives
To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC.
Materials and methods
We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms “prostate ductal adenocarcinoma” OR “endometriod adenocarcinoma of prostate” and variations of each.
Results
Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta‐analysis (range 0.0837%‐13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.
DAC was more likely to present as T3 (RR1.71; 95%CI 1.53‐1.91) and T4 (RR7.56; 95%CI 5.19‐11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84‐5.56; all P‐values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo‐therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer‐specific survival rates seem worse after RP.
Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC.
Conclusion
When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post‐treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub‐type.
Patient summary
Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow‐up. |
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| AbstractList | Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome.ContextDuctal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome.To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC.ObjectivesTo systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC.We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms "prostate ductal adenocarcinoma" OR "endometriod adenocarcinoma of prostate" and variations of each.Materials and methodsWe conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms "prostate ductal adenocarcinoma" OR "endometriod adenocarcinoma of prostate" and variations of each.Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all P-values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC.ResultsSome 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all P-values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC.When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type.ConclusionWhen drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type.Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up.Patient summaryDuctal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up. Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome. To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC. We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms "prostate ductal adenocarcinoma" OR "endometriod adenocarcinoma of prostate" and variations of each. Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all -values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC. When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type. Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up. Context Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome. Objectives To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC. Materials and methods We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms “prostate ductal adenocarcinoma” OR “endometriod adenocarcinoma of prostate” and variations of each. Results Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta‐analysis (range 0.0837%‐13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series. DAC was more likely to present as T3 (RR1.71; 95%CI 1.53‐1.91) and T4 (RR7.56; 95%CI 5.19‐11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84‐5.56; all P‐values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo‐therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer‐specific survival rates seem worse after RP. Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC. Conclusion When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post‐treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub‐type. Patient summary Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow‐up. ContextDuctal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome.ObjectivesTo systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC.Materials and methodsWe conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms “prostate ductal adenocarcinoma” OR “endometriod adenocarcinoma of prostate” and variations of each.ResultsSome 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all P-values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC.ConclusionWhen drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type.Patient summaryDuctal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up. |
| Author | Corcoran, Niall M. Omer, Altan Hamdy, Freddie C. Rajakumar, Timothy Erickson, Andrew Loda, Massimo Mills, Ian G. Verrill, Clare Lamb, Alastair D. Ranasinha, Nithesh Chow, Ken Bryant, Richard J. Davies, Lucy Harriss, Eli Murphy, Declan G. Philippou, Yiannis Chetta, Paolo M. Hovens, Christopher M. |
| AuthorAffiliation | 8 Weill Cornell Medical School New York NY USA 1 Nuffield Department of Surgical Sciences University of Oxford Oxford UK 9 NIHR Oxford Biomedical Research Centre University of Oxford, John Radcliffe Hospital Oxford UK 3 Bodleian Health Care Libraries University of Oxford Oxford UK 5 Dana Farber Cancer Institute Harvard MA USA 6 Division of Cancer Surgery Peter MacCallum Cancer Centre Melbourne VIC Australia 7 Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia 4 Department of Surgery Royal Melbourne Hospital University of Melbourne Melbourne VIC Australia 2 Department of Urology Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive Oxford UK |
| AuthorAffiliation_xml | – name: 5 Dana Farber Cancer Institute Harvard MA USA – name: 7 Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia – name: 6 Division of Cancer Surgery Peter MacCallum Cancer Centre Melbourne VIC Australia – name: 1 Nuffield Department of Surgical Sciences University of Oxford Oxford UK – name: 3 Bodleian Health Care Libraries University of Oxford Oxford UK – name: 9 NIHR Oxford Biomedical Research Centre University of Oxford, John Radcliffe Hospital Oxford UK – name: 2 Department of Urology Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive Oxford UK – name: 4 Department of Surgery Royal Melbourne Hospital University of Melbourne Melbourne VIC Australia – name: 8 Weill Cornell Medical School New York NY USA |
| Author_xml | – sequence: 1 givenname: Nithesh orcidid: 0000-0001-8888-9198 surname: Ranasinha fullname: Ranasinha, Nithesh email: nithesh.ranasinha@gmail.com organization: Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive – sequence: 2 givenname: Altan surname: Omer fullname: Omer, Altan organization: University of Oxford – sequence: 3 givenname: Yiannis surname: Philippou fullname: Philippou, Yiannis organization: University of Oxford – sequence: 4 givenname: Eli surname: Harriss fullname: Harriss, Eli organization: University of Oxford – sequence: 5 givenname: Lucy surname: Davies fullname: Davies, Lucy organization: University of Oxford – sequence: 6 givenname: Ken orcidid: 0000-0001-5904-2684 surname: Chow fullname: Chow, Ken organization: University of Melbourne – sequence: 7 givenname: Paolo M. surname: Chetta fullname: Chetta, Paolo M. organization: Dana Farber Cancer Institute – sequence: 8 givenname: Andrew surname: Erickson fullname: Erickson, Andrew organization: University of Oxford – sequence: 9 givenname: Timothy surname: Rajakumar fullname: Rajakumar, Timothy organization: University of Oxford – sequence: 10 givenname: Ian G. surname: Mills fullname: Mills, Ian G. organization: University of Oxford – sequence: 11 givenname: Richard J. orcidid: 0000-0002-8330-9251 surname: Bryant fullname: Bryant, Richard J. organization: Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive – sequence: 12 givenname: Freddie C. surname: Hamdy fullname: Hamdy, Freddie C. organization: Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive – sequence: 13 givenname: Declan G. orcidid: 0000-0002-7500-5899 surname: Murphy fullname: Murphy, Declan G. organization: University of Melbourne – sequence: 14 givenname: Massimo surname: Loda fullname: Loda, Massimo organization: Weill Cornell Medical School – sequence: 15 givenname: Christopher M. surname: Hovens fullname: Hovens, Christopher M. organization: University of Melbourne – sequence: 16 givenname: Niall M. surname: Corcoran fullname: Corcoran, Niall M. organization: University of Melbourne – sequence: 17 givenname: Clare surname: Verrill fullname: Verrill, Clare organization: University of Oxford, John Radcliffe Hospital – sequence: 18 givenname: Alastair D. orcidid: 0000-0002-2968-7155 surname: Lamb fullname: Lamb, Alastair D. email: alastair.lamb@nds.ox.ac.uk organization: Oxford University Hospitals NHS Foundation Trust, Roosevelt Drive |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35474657$$D View this record in MEDLINE/PubMed |
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| Copyright | 2021 The Authors. published by John Wiley & Sons Ltd on behalf of BJU International Company 2021 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | recurrence prostate cancer acinar carcinoma ductal carcinoma survival |
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Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion... Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still... ContextDuctal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion... |
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| SubjectTerms | acinar carcinoma ductal carcinoma Epidemiology Magnetic resonance imaging Pathology Prostate cancer Radiation therapy recurrence Review survival |
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| Title | Ductal adenocarcinoma of the prostate: A systematic review and meta‐analysis of incidence, presentation, prognosis, and management |
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