Back in September 2010, we reported on a paper that suggested that “men diagnosed with intraductal carcinoma of the prostate on needle biopsy should receive definitive therapy for locally advanced disease, even in the absence of pathologically documented invasive prostate cancer.”
A recently published review in the journal Prostate (by Bonkhoff et al.) now suggests that there is still a lack of appreciation that intraductal carcinoma of the prostate (IDCP) “represents a clinically aggressive disease that continues to be misreported under the diagnostic category of high grade prostatic intraepithelial neoplasia” (HG-PIN).
According to Bonkhoff et al., data from recent histological, molecular, and clinical studies show that IDCP differs significantly from HG-PIN, and that these differences have major impact in terms of diagnosis, prognosis, and therapy of this subtype of prostate cancer. Specifically, they go on to note that IDCP is associated with greater application of neoadjuvant androgen deprivation therapy (ADT), failure of chemotherapy, and early disease recurrence after external beam radiation. They also point out that IDCP is associated with the presence of TMPRSS2-ERG gene fusion, which has been reported to be regulated by estrogens and their receptors.
The authors argue that IDCP “is an aggressive phenotype of prostate cancer” and that it should be clearly differentiated from HG-PIN and carefully reported in pathologic reports on prostate biopsy and prostatectomy specimens.