Intraductal Carcinoma of the Prostate

Abstract

The histologic differential diagnosis of IDC-P on prostate needle biopsy includes high-grade prostatic intraepithelial neoplasia (HGPIN), invasive cribriform prostatic adenocarcinoma, prostatic ductal adenocarcinoma, and urothelial carcinoma extending into prostatic ducts. Diagnostic reproducibility is low in the category of intraductal lesions of the prostate (4) whereas, accurate diagnosis is crucial for patient management. When IDC-P is accompanied by invasive carcinoma, it is associated with higher grade and higher stage cancer. Isolated IDC-P (IDC-P unaccompanied by invasive cancer) on needle biopsy is generally associated with highgrade invasive prostatic adenocarcinoma on subsequent radical prostatectomy (2,4). IDC-P requires either definitive therapy or prompt rebiopsy. In contrast, HGPIN is considered a preneoplastic lesion; its presence does not require definitive therapy and in limited quantities, does not require rebiopsy. If urothelial carcinoma extending into prostatic ducts is identified on needle biopsy, radical cystoprostatectomy is recommended. Usual (acinar) prostatic adenocarcinoma and prostatic ductal adenocarcinoma are treated in the same manner and require definitive treatment.