Prostatic Ductal Adenocarcinoma: An Unusual Subtype of Prostate Cancer

Dinesh Kumar,John Lobo

doi:10.23937/2643-4563/1710013

Abstract

Ductal adenocarcinoma of the prostate (DAP) is defined as malignant epithelial cells filling large prostatic acini ducts, with preservation of basal cells forming either solid or dense cribriform patterns or a loose cribriform or micropapillary pattern with either marked nuclear atypia (nuclear size six times normal or larger) or Nonfocal comedonecrosis. DAP is a rare variant of prostate cancer, and has poorly-identified clinical characteristics. DAP is characterized by a high volume and high-grade disease, with an aggressive behavior. Few cases have been previously reported in Asian males and DAP is more commonly reported in Caucasian males over 70 years of age. In the present study, a 87 year old Asian American male patient that demonstrated nodular prostate with lower urinary tract symptoms and elevated prostatic specific antigen levels underwent a prostate biopsy.

Highlights

Malicow and Pachter first described a case of PDA in 1967 and were of the opinion that the tumor had “endometrial features” suggesting its origin from the prostatic utricle (Uterus masculinus) [1]
Subsequent studies have clearly confirmed the prostatic origin of Ductal adenocarcinoma of the prostate (DAP), which is supported by a favorable response to orchiectomy, the expression of prostatic-specific antigen (PSA) and ultrastructural findings [2]
It usually occurs in the prostatic urethra around the verumontanum, and its prognosis is generally thought to be worse than for acinar adenocarcinoma [4]

Summary

Introduction

Malicow and Pachter first described a case of PDA in 1967 and were of the opinion that the tumor had “endometrial features” suggesting its origin from the prostatic utricle (Uterus masculinus) [1]. DAP is a rare subtype of prostate cancer (PCa) that has a poorly-understood etiology, and more commonly occurs in Caucasian males that are > 70 years of age [3]. 87-year-old Asian American male with past history of nodular enlarge prostate with lower urinary tract symptoms (well managed with Alfuzosin 10 mg PO daily) and long-standing history of elevated and fluctuating PSA up to 16.5 ng/ml. He was evaluated with CT abdomen and pelvis for persistent RLQ and bilateral groin pain in Nov 2016 and found to have enlarge right pelvic lymph node concerning for lymph node metastasis and lobular enlarge prostate concerning for neoplasm. During the 1 year follow-up, the patient currently on ADT and remained progression-free with no evidence of local recurrence or distant metastasis

Discussion

Conclusion