Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program

Study Type – Prognosis (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Ductal prostate cancer is a rare histological variant of prostate cancer. The incidence, natural history and outcomes of patients with ductal have not been described. We demonstrate that ductal prostate cancers often present with advanced stage and a high percentage of men die from their disease. OBJECTIVE • To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers. PATIENTS AND METHODS • From the SEER registry, 693 men with ductal PCa were identified from 1970. • The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types. RESULTS • The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable. • Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa). • Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures. • Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa. • Comparing PCa-specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa. CONCLUSIONS • Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa-specific mortality similar to Gleason 4 + 4 acinar PCa. • Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.