The role of primary surgery and external beam radiation therapy in the management of non-metastatic ductal prostate cancer: 20-year outcomes from a single institution experience
Ductal carcinoma of the prostate (DAC) is a rare histological subtype of prostate cancer (PC). Although it is reported to be an aggressive tumor, often with locally advanced and/or metastatic disease at presentation, the available literature still lacks of reports on treatment recommendations since there are still controversies about the optimal therapeutic approach. We present our 20-year outcome of multidisciplinary management of non-metastatic DAC (nmDAC).
A retrospective analysis of our Institutional Urology-Radiation Oncology database was performed. Patients (pts) with nmDAC undergoing radical treatment were included. All these pts were discussed at our multidisciplinary Oncology board in order to highly personalize the treatment. The cohort was divided into three groups according to received treatment: group A surgery (either radical prostatectomy or cystectomy), group B surgery and post-operative radiation therapy (RT, either adjuvant or salvage) and group C RT alone. Kaplan-Meier method was used to estimate survival outcome, after adjusting for predictive variable (age, comorbidities, pathological stage, histology). Statistical analysis was performed using SPSSv20, considering statistically significant p value <0,05.</p>
The features of the population in study are summarized in Table 1. From 1997 to 2016, about 8470 PC pts underwent radical treatment at our Institution, 71 were diagnosed with nmDAC (0.84%): group A with 21 patients (29.6%), group B 27 (38%) and group C 23 (32.4%). Histological examination showed 17 pure DAC (23.9%) and 56 mixed DAC and acinar adenocarcinoma (78.9%). At a median follow-up time of 60 and 120 months, overall survival (OS) was 86% and 70% respectively for group A, 100% and 92% for group B, 65% and 49% for group C (p=0.054). Pure DAC undergoing surgery showed an OS at a median follow up of 60 months of 34%, while adding post-operative RT leads to a OS of 100% (p=0.029).
DAC is a rare, often aggressive subtype of PC, especially in pure form. Our large series seems to support the role of a radical, aggressive, combined therapeutic approach, when feasible, in order to achieve better local disease control and long-term survival outcome.