Prostatic Ductal Adenocarcinoma Diagnosed on Transurethral Biopsy or Transurethral Resection of the Prostate (TURP) Is Not Always Clinically Aggressive Disease
H Aydin, J Zhang, H Samaratunga, C Magi-Galluzzi, M Zhou. Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; Brisbane, QLD, Australia
Background: Prostatic ductal adenocarcinoma (DCa-P) is considered to be an aggressive variant of prostate carcinoma (PCa) equivalent to Gleason score 8 PCa. We studied the pathological outcome of 23 DCa-P diagnosed on transurethral biopsy or TURP.
Design: DCa-P diagnosed on transurethral biopsy or TURP was identified by searching the surgical pathology files at authors' institutions. Those cases with concomitant acinar PCa component were not included. Patients' demographic information, serum PSA levels, follow-up surgical procedures (radical prostatectomy [RP], TURP, or transrectal biopsy) and follow-up pathological outcomes were obtained.
Results: 23 patients were studies. Their man age was 67.5 (range 44-82) years. The prebiopsy PSA was 13.1 (range 0.15-65) ng/ml. DCa-P was diagnosed on transurethral biopsy in 14 patients and on TURP in 9 patients. Only ductal cancer component was present and no acinar PCa component was present in the biopsies. Three patients had a prior history of PCa. The remaining 20 patients had follow-up procedures within 4 (range 1-23) months after the initial transurethral biopsy or TURP, including 2 with transcrectal biopsy, 5 with TURP and 13 with RP. All 5 patients with prior or follow-up transrectal biopsies had biopsy-proven PCa. Of 5 patients with follow-up TURP, 4 had Gleason score>8 PCa. However, one patient did not have residual cancer. Of 13 patients with RP, 4 had GS 7 PCa, 8 had GS>8 PCa. Extraprostatic extension was present in 7/12, seminal vesicle invasion was present in 6/12, and lymph node metastasis was present in 2/12 patients. Three patients had GS 7, organ-confined disease. One patient did not have residual disease. Therefore of 18 patients with follow-up TURP and RP, 13/18 (72%) had high grade PCa, 3/18 (17%) had GS 7 and organ confined PCa , and 2/18 (11%) had no residual disease.
Conclusions: While the majority of DCa-P diagnosed on transurethral biopsy or TURP is associated with high grade PCa with adverse pathological features, a subset has GS7 and organ-confined disease. In addition, a subset of patients with DCa-P diagnosed on transurethral biopsy had no residual cancer. We recomment that patients with a diagnosis of DCa-P diagnosed on transurethral biopsy or TURP undergo follow-up TURP and/or transrectal prostate biopsy to confirm the presence of extensive disease before definitive therapy is offered.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 126, Tuesday Afternoon