Acinar adenocarcinoma of the prostate is a common form of cancer affecting the prostate gland in men. This type of cancer originates in the glandular cells of the prostate, which are responsible for producing seminal fluid. It represents a large majority, about 90% to 95%, of all prostate cancer diagnoses.
The term “acinar” specifically refers to the acini cells, which are organized into small, round clusters that form the prostate’s fluid-secreting glands. Under a microscope, acinar adenocarcinoma cells may appear different from normal glandular cells, often forming smaller, disorganized glands compared to the well-defined lobular structures of healthy prostate tissue. While some prostate cancers can be aggressive, acinar adenocarcinoma is often characterized by a slower growth pattern.
Understanding Acinar Adenocarcinoma
Acinar adenocarcinoma develops from the epithelial cells lining the prostate gland. Under microscopic examination, these cancerous cells show distinct features, such as larger nuclei and prominent nucleoli, unlike benign cells. Malignant glands also lack the typical double-layered epithelium found in healthy prostate tissue, instead presenting a single layer of lining cells.
Compared to rarer types like prostatic ductal adenocarcinoma, acinar adenocarcinoma is generally less aggressive and grows at a slower pace. Ductal adenocarcinoma, which develops in the prostate’s ducts, is characterized by tall, layered columns of abnormal epithelial cells and tends to recur and spread more quickly. While acinar adenocarcinoma’s progression can vary significantly among individuals, it typically grows slowly.
Detecting Prostate Acinar Adenocarcinoma
Detection often begins with screening tests such as the Prostate-Specific Antigen (PSA) blood test and a digital rectal exam (DRE). The PSA test measures a protein produced by prostate cells, and elevated levels can indicate prostate cancer, though other non-cancerous conditions can also cause high PSA. During a DRE, a doctor manually examines the prostate for any unusual lumps or changes in texture.
If initial screenings suggest an abnormality, a prostate biopsy confirms the diagnosis. This procedure often involves a transrectal ultrasound-guided biopsy, where multiple small tissue samples are taken from different areas of the prostate. A pathologist then examines these samples under a microscope to identify cancer cells and determine their aggressiveness using the Gleason grading system. The Gleason score, ranging from 6 to 10, indicates how much the cancer cells differ from normal cells, with lower scores indicating slower-growing, less aggressive cancer.
Managing Acinar Adenocarcinoma of the Prostate
Treatment plans for acinar adenocarcinoma are tailored to each individual, considering factors like the cancer’s severity, patient preferences, and overall health. For low-risk cases, active surveillance may be recommended, which involves closely monitoring the cancer with regular PSA tests and biopsies. This approach is suitable when the cancer is asymptomatic and not expected to progress rapidly.
When treatment is necessary, radical prostatectomy, the surgical removal of the prostate gland and sometimes nearby lymph nodes, is a common option for cancer localized to the prostate. Radiation therapy is another widely used treatment, delivering high-energy radiation to destroy cancer cells, either externally (external beam radiation therapy) or internally through radioactive pellets placed in the prostate (brachytherapy). Hormone therapy, also known as androgen deprivation therapy, reduces male sex hormones that can fuel cancer growth and is often combined with surgery or radiation. For more advanced cases, chemotherapy, which uses anti-cancer drugs, or newer targeted therapies and immunotherapy may be considered.
Outlook and Ongoing Care
Acinar adenocarcinoma of the prostate generally carries a favorable outlook, particularly when detected early. The 5-year survival rate for localized prostate cancer is nearly 100%, and the 10-year survival rate is around 98%. Even 15 years after diagnosis, the survival rate remains high at about 95%.
After treatment, regular follow-up appointments are important, including continued PSA monitoring to detect any signs of recurrence. A rising PSA level after treatment, especially after surgery where it should ideally drop to zero, can indicate recurrence. Patients may experience potential side effects from treatments, such as urinary or sexual function changes. These long-term considerations are discussed with patients to manage expectations and quality of life.