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Prostatic ductal adenocarcinoma variant predicts worse pathological and oncological outcomes: Insight from over 1000 consecutive patients from a large prospective uro‐oncology registry
Author(s) -
Tan Yu Guang,
Khalid Farhan,
Huang Hong Hong,
Chen Kenneth,
Tay Kae Jack,
Lau Weber K. O.,
Cheng Christopher W. S.,
Ngo Nye Thane,
Yuen John S. P.
Publication year - 2021
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.24100
Subject(s) - medicine , hazard ratio , prostatectomy , pathological , urology , prospective cohort study , adenocarcinoma , confidence interval , prostatic adenocarcinoma , biopsy , prostate , oncology , gastroenterology , cancer
Objective To evaluate if prostatic ductal adenocarcinoma (PDA) independently predicts poorer pathological and oncological outcomes after radical prostatectomy (RP). Methods and Materials Utilizing a large prospective uro‐oncology registry, clinicopathological parameters of 1027 consecutive patients who underwent RP (2008–2017) were recorded. Oncological outcomes were determined by failure to achieve unrecordable PSA postoperatively and biochemical failure (BCF). Results PDA was present in 79 (7.7%) patients, whereas 948 (92.3%) patients had conventional prostatic acinar adenocarcinoma (PAA). Patients with PDA were older (mean 64.4 vs. 62.8‐years old; p = .045), had higher PSA at diagnosis (mean 12.53 vs. 10.80 ng/ml; p = .034), and a higher percentage of positive biopsy cores (mean 39.34 vs. 30.53%; p = .006). Compared to PAA, PDA exhibited a more aggressive tumor biology: (1) Grade groups 4 or 5 (26.6 vs. 9.4%, p < .001), (2) tumor multifocality (89.9 vs. 83.6%; p = .049), and (3) tumor size (mean 2.97 vs. 2.00 cm; p < .001). On multivariate analysis, PDA was independently associated with locally advanced disease ( p = .002, hazard ratio [HR]: 2.786, 95% confidence interval [CI]: 1.473–5.263), with a trend towards positive surgical margins ( p = .055) and nodal involvement ( p = .061). Translating the poorer pathological features to oncological outcomes, presence of PDA independently predicted less likelihood of achieving unrecordable PSA ( p = .019, HR: 2.368, 95% CI: 1.152–4.868, and higher BCF ( p = .028, HR: 1.918, 95% CI: 1.074–3.423). Subgroup analysis demonstrated that a higher ductal component greater than 15% proportionally predicted worse oncological outcomes, with a shorter time to BCF of 14.3 months compared to 19.8 months in patients with ductal component lesser than 15% ( p = .040, HR: 2.660, 95% CI: 1.046–6.757). Conclusion PDA is independently associated with adverse pathological and oncological outcomes after RP. A higher proportion of PDA supports a higher BCF rate with a shorter time interval. An aggressive extirpative approach with close monitoring of postoperative serum PSA levels is warranted for these patients.