Prostate cancer involves the uncontrolled growth of cells within the prostate, a gland located below the bladder in the male reproductive system. While many prostate cancers grow slowly and may not cause significant health issues, some types are more aggressive. Ductal prostate cancer (DPC) is a distinct and less common form of prostate cancer that exhibits unique characteristics compared to the more prevalent types.
Understanding Ductal Prostate Cancer
Ductal prostate cancer (DPC) is a rare subtype of prostate cancer. Unlike acinar adenocarcinoma, which originates from the glandular cells, DPC arises from the ducts within the prostate gland. DPC is more aggressive than acinar adenocarcinoma, often diagnosed at a later stage, and tends to grow and spread quickly. Histologically, DPC often presents in papillary or cribriform patterns and is typically classified with a higher Gleason grade, such as 4+4 or higher.
Recognizing Signs and Symptoms
The signs and symptoms of ductal prostate cancer often overlap with those of other prostate conditions, but they can sometimes be more noticeable due to the tumor’s location within the periurethral ducts.
Many individuals with DPC experience lower urinary tract symptoms. These symptoms can include difficulty initiating urination, a weak or interrupted urine flow, frequent urination, and a sensation of incomplete bladder emptying.
Blood in the urine (hematuria) or painful ejaculation can also occur. Some patients may experience erectile dysfunction. As the cancer progresses or spreads, individuals might report pain in the pelvic area or bones, unexplained weight loss, leg swelling, or shortness of breath.
Diagnosis and Staging
The diagnostic process for ductal prostate cancer typically begins with initial screenings, such as a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). An elevated PSA level can indicate an increased risk for prostate cancer, although other conditions can also cause high PSA. The DRE allows a doctor to manually feel for abnormalities in the prostate. However, DPC may present with lower PSA levels than acinar adenocarcinoma, and a DRE may be normal if the tumor is located near the urethra.
A definitive diagnosis of DPC requires a prostate biopsy, where small tissue samples are removed and examined under a microscope. This biopsy is often guided by imaging techniques like transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI) to ensure accurate sampling. The specific histological patterns, such as papillary or cribriform architecture, are identified by a pathologist to confirm DPC.
Following diagnosis, imaging techniques are used for staging to determine the extent of cancer spread. MRI is frequently employed to evaluate the prostate and nearby organs, providing detailed images of the tumor’s size and local extension. Computed tomography (CT) scans and bone scans are also used to check for spread to lymph nodes or bones, respectively. Accurate staging is important for guiding treatment decisions, as DPC often presents at a more advanced pathological stage.
Treatment Strategies
Treatment for ductal prostate cancer often involves more aggressive approaches due to its inherent nature. Surgical removal of the prostate, known as radical prostatectomy, is a common option for localized disease. This procedure may include pelvic lymph node dissection, especially since DPC can involve lymph nodes and may not show up on certain scans. Nerve-sparing techniques during surgery might be approached with caution due to the potential for extraprostatic disease.
Radiation therapy is another primary treatment modality, often used in conjunction with other therapies. External beam radiation therapy (EBRT) delivers radiation from outside the body, while brachytherapy involves placing radioactive seeds directly into the prostate. Radiation therapy may be given after surgery to target any remaining cancer cells and reduce recurrence risk. Studies have shown that radiation therapy combined with hormonal therapy can improve survival outcomes for those with localized or locally advanced prostate cancer.
Hormonal therapy, also called androgen deprivation therapy (ADT), reduces the levels of male hormones that fuel prostate cancer growth. ADT can involve surgical castration or medical castration using medications like LHRH agonists or antagonists. Chemotherapy, such as docetaxel, is often used for metastatic DPC, particularly when the cancer has spread to distant body parts. Treatment decisions are individualized, considering the cancer’s stage and grade, as well as the patient’s overall health, with combination therapies frequently employed to achieve better outcomes.
Prognosis and Management
The prognosis for individuals with ductal prostate cancer can vary considerably, influenced by factors such as the stage at diagnosis and the cancer’s response to treatment. DPC is generally associated with a poorer overall survival rate compared to the more common acinar adenocarcinoma, with a higher likelihood of metastatic disease at diagnosis. For instance, a review noted that DPC spread to distant body parts 4.62 times more often than acinar adenocarcinoma at diagnosis.
Ongoing monitoring and follow-up care are important for managing DPC long-term. This typically includes regular PSA blood tests, often every three months for the first year, then every six months, and annually after five years. Imaging techniques, such as CT scans of the chest and bone scans, are also used periodically to detect recurrence or progression, especially given DPC’s propensity to metastasize to sites like the lungs, bones, penis, and testes. A multidisciplinary care team, involving various specialists, contributes to comprehensive management and surveillance.