Radical Prostatectomy (RP) Findings in Cases with Only Intraductal Carcinoma of the Prostate (IDC-P) on Needle Biopsy
BD Robinson, JI Epstein. The Johns Hopkins Hospital, Baltimore
Background: When IDC-P is present on biopsy, it is usually seen with infiltrating acinar adenocarcinoma. In 2006, we reported 27 cases with IDC-P only on biopsy; however, only 6 cases had available RP findings.
Design: 82 men with IDC-P only on prostate biopsy were identified from the consult files of one of the authors. Follow-up information was available in 66 cases. 20 men were treated with RP, 17 radiation therapy (RT), 8 hormone therapy (HT), 13 RT and HT, 6 active surveillance, and 2 rebiopsy. An attempt was made to retrieve the slides of all 20 RP cases.
Results: Of the 20 RP cases, 5 showed extraprostatic extension, 3 seminal vesicle invasion, 10 were organ-confined, and 2 showed extensive IDC-P only without identifiable invasive cancer. Of the 18 cases with invasive cancer, the average Gleason score (GS) was 7.8. 1 patient developed bone metastases 3 years post-RP, and 3 others were post-RP PSA failures. 13 RPs were available for our review. 9 showed extensive IDC-P (including one case of IDC-P only), defined as >10% of the tumor volume being intraductal; 3 focal IDC-P; and 1 no IDC-P. All cases with invasive carcinoma were acinar, although 3 cases were classified as ductal by referring pathologists. We concurred with the outside GS in 5/13 cases (5 undergraded, 3 overgraded). In the 3 cases that we gave lower GS, the outside institution graded cribiform IDC-P with and without necrosis as Gleason pattern 5 or 4, respectively.
|Case||Outside GS||JHH GS||Extent IDC||pStage||RP Sampling|
|2||IDC only||IDC only||Extensive||Total|