Intraductal carcinoma of the prostate (IDCP)


Intraductal carcinoma of the prostate is occasionally (but rarely) diagnosed on prostate biopsy and is more commonly evident in radical prostatectomy specimens. Basically, this is a type of prostate cancer in which malignant epithelial cells fill large acini and prostatic ducts, and has other specific pathological features.

In 2006, Guo and Epstein published a commentary on the pathology of biopsy-detected IDCP based on 27 cases. At that time they concluded that biopsy-detected IDCP “is frequently associated  with high-grade cancer and poor prognostic parameters at radical prostatectomy as well as potentially advanced disease following other therapies.” They recommended that patients with IDCP on biopsy should be considered as candidates for aggressive treatment even if there were no other signals for high-risk disease.

In a new article, Robinson and Epstein have updated that earlier commentary, based on access to data from a total of 83 patients initially diagnosed only with IDCP. In this new article the authors focus specifically on the 21 patients for whom they had access to detailed post-surgical data (see below). Overall, the 83 patients had been treated by radical prostatectomy (n = 23), radiation therapy (n = 15), hormone therapy (n = 8), radiation + hormone therapy (n = 15); 5 men either had no treatment or had a repeat biopsy.

Here are Robinson and Epstein’s core findings from the 21 patients who underwent  a radical prostatectomies and for whom they had access to follow-up pathological and clinical data:

  • The pathological stages of these 21 patients post-surgery were  pT3a (n = 8, 38 percent), pT3b (n = 3, 13 percent), pT2 (n = 8, 38 percent) and intraductal carcinoma without identifiable invasive cancer (n = 2, 10 percent).
  • One patient with pT3a disease had a positive lymph node.
  • The patients’ average (mean?) Gleason score was 7.9.
  • 3 patients (14 percent) demonstrated biochemical failure post-surgery; 1 additional patient (5 percent) had bone metastases 2.5 years post-surgery.

Robinson and Epstein conclude that men with only IDCP at biopsy typically have high-grade, invasive adenocarcinoma of the prostate (Gleason score ≥ 7) and that most of these patients are shown to have locally advanced disease (pT3) if they go on to have a radical prostatectomy. They make the clear recommendation 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.

6 Responses

  1. This is important information to be aware of.

    I just want to comment that the Sitemaster has been doing an exceptional job in bringing to our attention so many interesting and important subjects regarding our insidious men’s disease. The “New” Prostate Cancer InfoLink is an excellent source of information and we should all bring this site to the attention of fellow prostate cancer patients, their caregivers, and others interested in learning more about prostate cancer and its appropriate treatment. My thanks, too, to urologist Arnon Krongrad for making this website possible.

  2. Looking for opinions re treatment for a recent 55-year-old patient with Gleason 8 IDCP dx’d with a urethral bx of a papillary excrescence (also Gleason 8 IDCP), negative bone and CT scans, who underwent RRP. Final pathology: extensive Gleason 8 throughout prostate, ? positive margin one side, SV invasion with negative nodes. PSA only fell from 8 to 3. Patient is now 6 weeks post-op. Any ideas for adjuvant therapies?

  3. Dear Dr. Libby:

    I doubt that the average patient that reads this site regularly would be able to offer a constructive opinion on this patient, but I have brought your question to the attention of our medical director to see if he has any suggestions. You might also want to contact Dr. Epstein at Johns Hopkins for his opinion. The above-mentioned paper would appear to suggest that adjuvant radiation therapy (with or without a period of androgen deprivation) might be appropriate for such a patient. However, I am not a physician.

  4. Dear Dr. Libby,

    A similar situation came up recently with one of my patients, at which time a review turned up essentially nothing that would objectively and scientifically guide a primary treatment decision.

    On the assumption that there is no urinary infection and that the PSA is not a chance lab error, then it would appear that the literature offers no specific change in management based upon the specific histology.

    Arnon

  5. A friend of mine has intraductal carcinoma of the prostate with a Gleason score 7. He is going in for radiation bead therapy. What is the survival rate on this?

  6. Dear Judy:

    I am not aware of any really good long-term follow-up data on the treatment of men with IDCP that would allow a specific projection of long-term survival for a man with IDCP and a Gleason score of 7. However, I am also not aware of any data to suggest that this type of prostate cancer is necessarily any more aggressive than any other type of adenocarincoma of the prostate. It is therefore reasonable to believe that your friend should do very well if he is appropriately treated with permanent radioactive seed implantation (“brachytherapy”) by an appropriately skilled and experienced specialist. Long-term, prostate cancer-specific survival for such patients is normally in excess of 15 years if the patient had an initial PSA level of not more than 15 ng/ml.

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