Ductal more aggressive than acinar prostate carcinoma
MedWire News: Ductal carcinoma is an aggressive form of prostate cancer that predicts worse overall patient survival than the more common acinar tumor, show US study results.
Importantly, men with ductal carcinomas also have lower prostate-specific antigen (PSA) levels than those with acinar carcinomas, which could adversely affect timely detection of the disease, say the researchers.
"The decreased likelihood of identifying these tumors by PSA screening may have a role in the increased aggressiveness of ductal cancer due to delayed diagnosis," suggest Jonathan Wright, from the University of Washington in Seattle, and colleagues.
Writing in the Journal of Urology, the team reports their characterization of 371 ductal carcinoma cases and 442,881 acinar cases diagnosed from 1996-2006, in terms of clinicopathological variables and survival outcome.
More ductal cases than acinar carcinoma cases presented with poorly differentiated disease (Gleason score 8-10), at 50% versus 32%, observed the team. Ductal carcinoma also presented more frequently as distant (compared with localized or regional) disease, at 12% versus 4% in acinar carcinoma patients.
Among patients who were treated with radical prostatectomy (n=137,719), those with ductal prostate cancer were significantly more likely to have extracapsular extension of disease.
Disease-specific survival was significantly different between ductal and acinar patients. After adjustment for factors including age, race, grade, and clinical T stage, ductal patients were 2.2 times more likely to die from prostate cancer than acinar patients.
The same adjusted analysis also showed that men with ductal cancer had 30% lower geometric mean PSA levels than those with acinar carcinomas.
Finally, the odds for having a PSA level below 4 ng/ml (a cutoff commonly used to indicate prostate biopsy) were 2.4-fold higher in men with ductal tumors, "suggesting that these cancers are less likely to be detected by PSA screening than acinar adenocarcinoma," write Wright et al.
They conclude: "These findings suggest that detecting ductal carcinoma on pathological evaluation independently predicts a worse overall prognosis."
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By Sarah Guy