Abstract
BackgroundTo explore whether metastatic castration‐resistant prostate cancer (mCRPC) patients with distinct intraductal carcinoma of the prostate (IDC‐P) subtypes respond differently to abiraterone and docetaxel treatment.MethodsWe retrospectively analyzed data of 170 mCRPC patients receiving abiraterone or docetaxel as first‐line therapy. PSA response, PSA progression‐free survival (PSA‐PFS), radiographic progression‐free survival (rPFS), and overall survival (OS) were analyzed based on the presence of IDC‐P and its subpatterns.ResultsIDC‐P was confirmed in 91/170 (53.5%) patients. Among them 36/91 (39.6%) and 55/91 (60.4%) harbored IDC‐P patterns 1 and 2, respectively. Patients with IDC‐P pattern 1 shared similar clinical outcomes to those without IDC‐P in both abiraterone and docetaxel treatment. However, against cases without IDC‐P or with IDC‐P pattern 1, patients with IDC‐P pattern 2 had markedly poorer prognosis in either abiraterone (mPSA‐PFS: 11.9 vs. 11.1 vs. 6.1 months, p < 0.001; mrPFS: 18.9 vs. 19.4 vs. 9.6 months, p < 0.001) or docetaxel (mPSA‐PFS: 6.2 vs. 6.6 vs. 3.0 months, p < 0.001; mrPFS: 15.1 vs. 12.6 vs. 5.5 months, p < 0.001) treatment. For patients without IDC‐P, docetaxel had comparable therapeutic efficacy with abiraterone. However, the efficacy of docetaxel was significantly inferior to abiraterone in patients with either IDC‐P pattern 1 (mPSA‐PFS: 6.6 vs. 11.1 months, p = 0.021; mrPFS: 12.6 vs. 19.4 months, p = 0.027) or pattern 2 (mPSA‐PFS: 3.0 vs. 6.1 months, p = 0.003; mrPFS: 5.5 vs. 9.6 months, p = 0.007).ConclusionCompared to docetaxel, abiraterone exhibited better efficacy in patients with IDC‐P of either pattern. However, IDC‐P pattern 2 responded unsatisfactorily to either abiraterone or docetaxel therapy. Novel therapeutic strategies for IDC‐P pattern 2 need further investigations.
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