Characterising prostate ductal adenocarcinoma: morphometry and clinical outcomes
Ductal adenocarcinoma is a rare variant of prostate cancer, demonstrating a more aggressive phenotype than conventional acinar adenocarcinoma. Morphometric variables, including distance from the urethra and tumour volume, remain unclear in present literature. This study aimed to examine the relationship between morphometry and clinical outcomes, particularly biochemical recurrence, and to further characterise the morphometry of ductal tumours.
A comparative cohort study of ductal and Gleason 8+ acinar adenocarcinoma patients who had undergone radical prostatectomy between February 2007 and February 2017 was undertaken. Ductal and acinar foci were outlined under direct microscopy and morphometric measurements taken. MRI and clinical data were then compared.
68 ductal and 72 acinar adenocarcinomas were included. Ductal tumours were located further from the periphery by 0.3 mm (p = 0.02), and involved 5% more prostate area (p = 0.02). Ductal proportions were reported in 52.7% of cases and identified in another 5% initially labelled as acinar-only. Risk of biochemical recurrence increased per 10% ductal components (HR 1.129, 95%CI 1.023–1.246, p = 0.02), and was substantially higher in tumours with ductal components greater than 50% (HR 2.226, 95%CI 1.110–4.464, p = 0.024).
This is the first study to demonstrate a significant relationship between the proportion of ductal components and clinical outcomes, and our findings suggest that more aggressive management strategies are required for patients with higher ductal proportions.
Funding: Malcolm Coptcoat Trust Foundation