Rare Variant Of Prostate Cancer Research Articles

MpMRI features of mucinous prostate cancer: two case reports

BackgroundMucinous adenocarcinoma of the prostate (MACP) is one of the rarest variants of prostatic neoplasm, with more aggressive behavior than non-mucinous prostatic cancer. Previous studies suggested that these tumors exhibit different imaging magnetic resonance imaging (MRI) features compared with those of non-mucinous adenocarcinoma of the prostate upon which the conventional PIRADS v2.1 is based. To the best of our knowledge, this case series is the first to describe the multiparametric magnetic resonance imaging features of the MACP.ResultsWe presented two cases of biopsy proven mucinous adenocarcinoma of the prostate studied with multiparametric MRI. In both cases, diagnosis was late because of the different MRI features of MACP than those of the more common adenocarcinoma of the prostate. In both mpMRI, MACP appears to be hyperintense on T2WI, there was not a significant decrease in diffusivity in ADC maps and it exhibits early enhancement in DCE-MRI; the septa resulted in hypointense on T2WI compared to the PZConclusionsAccording to our experience, the conventional PIRADS v2.1 score is not suitable for mucinous prostate adenocarcinoma. MACP appears to be hyperintense on T2WI, has a lower ADC value, and exhibits early enhancement in DCE-MRI; the septa are usually hypointense on T2WI compared to the PZ. It is imperative for radiologists and urologists to be cognizant of this rare variant of prostate cancer to promptly identify and diagnose it, thereby preventing any diagnostic delays.

On a case of prostatic Sarcomatoid carcinoma

Sarcomatoid carcinoma of the prostate is a very rare variant of prostate cancer; it generally consists of malignant glandular elements and spindle cells, while the sarcomatoid component ranges from 5 to 99 percent. It can affect both young and old, with the onset of symptoms ranging from difficulty urinating to incomplete emptying. In addition, this form of neoplasm tends to metastasize frequently to bones, lungs, and liver.

Pure prostatic ductal adenocarcinoma with elevated prostate-specific antigen level: a rare case report and literature review

Introduction: Prostatic ductal adenocarcinoma (PDA) is rare, representing approximately 0.4 to 0.8% of all prostate malignancies. It usually occurs in the prostatic urethra around verumontanum, its prognosis is generally considered to be worse compared to acinar adenocarcinoma.Case description: We present a 75-year-old male with PDA with an elevated PSA level. PDA histologically characterized by pseudostratified columnar cells. It is associated with aggressive behavior with an overall poor prognosis. Although normal PSA is a common finding in those with PDA, the presence of elevated PSA levels should not be used to exclude the possibility of PDA.Conclusion: PDA is a rare variant of prostate cancer which is histologically characterized by pseudostratified columnar cells. Although normal PSA is a frequent finding in those with PDA, the presence of elevated PSA should not be used to exclude the possibility of PDA.

The Role of Radiotherapy Among Patients With Prostate Ductal Adenocarcinoma

The aim of this study was to perform a Surveillance, Epidemiology, and End Results (SEER) analysis on the effect of radiotherapy (RT) on survival among patients with prostate ductal adenocarcinoma (DA), a rare variant of prostate cancer. Cases of T1 to 4 N0 M0 prostate DA diagnosed between 2004 and 2013 were extracted from SEER. The association between categorical variables and radiation therapy was assessed for statistical significance using the χ2 test or Fisher exact test. Difference in continuous variables across the RT groups was assessed for statistical significance using the 2-sample t test or non-parametric test. The distribution of overall survival (OS) and disease-specific survival (DSS) between the RT groups was assessed using the Kaplan-Meier method and the log rank test and after propensity matching. The association between hazards of death (HR) and covariates was examined using Cox proportional hazards model. A 2-sided P-value of .05 was used to determine statistical significance. A total of 205 patients met inclusion criteria. On univariate analysis, RT was associated with significant improvement in OS and DSS. On multivariate Cox regression, RT significantly decreased risk of death for both OS and DSS (HR, 0.516; 95% confidence interval [CI], 0.273-0.978 and HR, 0.232; 95% CI, 0.082-0.658, respectively). After propensity score matching, RT demonstrated a persistent improvement in both OS and DSS. RT decreased risk of death for both OS and DSS in patients with node-negative, nonmetastatic prostate DA on multivariable analysis. RT was also associated with improved OS and DSS after propensity matching.

Prostatic Carcinoma With Aberrant Expression of p63: A Case Report and Review of the Literature

Abstract Prostatic carcinoma with aberrant expression of p63 is a rare variant of prostate cancer, which represents a potential diagnostic pitfall, as it may be easily confused with either benign prostatic glands or high-grade prostatic carcinoma. In studies of radical prostatectomies, these tumors appear to behave like low-grade carcinomas despite frequent poorly formed architecture. We report a case of prostatic carcinoma with aberrant expression of p63 with a review of the literature and helpful features in the differential diagnosis of this entity.

Sequencing Small Non-coding RNA from Formalin-fixed Tissues and Serum-derived Exosomes from Castration-resistant Prostate Cancer Patients.

Ablation of androgen receptor (AR) signaling by androgen deprivation is the goal of the first line of therapy for prostate cancer that initially results in cancer regression. However, in a significant number of cases, the disease progresses to advanced, castration-resistant prostate cancer (CRPC), which has limited therapeutic options and is often aggressive. Distant metastasis is mostly observed at this stage of the aggressive disease. CRPC is treated by a second generation of AR pathway inhibitors that improve survival initially, followed by the emergence of therapy resistance. Neuroendocrine prostate cancer (NEPC) is a rare variant of prostate cancer (PCa) that often develops as a result of therapy resistance via a transdifferentiation process known as neuroendocrine differentiation (NED), wherein PCa cells undergo a lineage switch from adenocarcinomas and show increased expression of neuroendocrine (NE) lineage markers. In addition to the genomic alterations that drive the progression and transdifferentiation to NEPC, epigenetic factors and microenvironmental cues are considered essential players in driving disease progression. This manuscript provides a detailed protocol to identify the epigenetic drivers (i.e., small non-coding RNAs) that are associated with advanced PCa. Using purified microRNAs from formalin-fixed paraffin-embedded (FFPE) metastatic tissues and corresponding serum-derived extracellular vesicles (EVs), the protocol describes how to prepare libraries with appropriate quality control for sequencing microRNAs from these sample sources. Isolating RNA from both FFPE and EVs is often challenging because most of it is either degraded or is limited in quantity. This protocol will elaborate on different methods to optimize the RNA inputs and cDNA libraries to yield most specific reads and high-quality data upon sequencing.

Prostatic Ductal Adenocarcinoma: An Unusual Subtype of Prostate Cancer

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.

MP66-09 A CONTEMPORARY ANALYSIS OF TREATMENT SELECTION AND COMPARATIVE EFFICACY OF TREATMENT FOR MEN WITH DUCTAL CARCINOMA OF THE PROSTATE

INTRODUCTION AND OBJECTIVES:Ductal carcinoma of the prostate (DCP) is a rare variant of prostate cancer. Consensus regarding the optimal treatment approach for patients with non-metastatic DCP is c...

Ductal Carcinoma of the Prostate: An Uncommon Entity With Atypical Behaviour

AimsDuctal adenocarcinoma is a rare variant of prostate cancer, and as such clinical outcomes and best management are not well defined. This series demonstrates the atypical presentation and unusual clinical behaviour of ductal adenocarcinoma and proposes management guidelines to assist clinicians. Materials and methodsA retrospective review of pure (nine patients) and mixed (18 patients) ductal adenocarcinoma of the prostate referred to the Departments of Radiation Oncology of the Sydney Cancer Centre, Royal Prince Alfred Hospital and Northern Sydney Cancer Centre, Royal North Shore Hospital, between 2000 and 2015. ResultsTwenty-seven patients were treated with definitive radiotherapy, nine patients (33%) with pure ductal and 18 (67%) with mixed ductal-acinar adenocarcinoma. The median follow-up was 38 months. Four patients (15%) failed locally, all of whom received less than 80 Gy, or no brachytherapy boost. Five patients (19%) failed distantly, four with biopsy-proven lung metastases. All distant failures occurred with a prostate-specific antigen (PSA) < 3 ng/ml. ConclusionThis series shows the atypical clinical presentation of this entity, as well as its propensity to metastasise to unusual sites. Relapse may occur at low absolute PSA values and is often asymptomatic. Ductal cancer should not simply be regarded as a high Gleason grade cancer. We propose management guidelines, including regular computed tomography examinations (rather than relying solely on PSA levels) as part of the follow-up for patients with any component of ductal adenocarcinoma.

MP34-10 CHARACTERISING PROSTATE DUCTAL ADENOCARCINOMA: MORPHOMETRY AND CLINICAL OUTCOMES

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2018MP34-10 CHARACTERISING PROSTATE DUCTAL ADENOCARCINOMA: MORPHOMETRY AND CLINICAL OUTCOMES Timothy Harkin, Ashish Chandra, Oussama Elhage, Mark Frydenberg, and Prokar Dasgupta Timothy HarkinTimothy Harkin More articles by this author , Ashish ChandraAshish Chandra More articles by this author , Oussama ElhageOussama Elhage More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , and Prokar DasguptaProkar Dasgupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1102AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e441 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Timothy Harkin More articles by this author Ashish Chandra More articles by this author Oussama Elhage More articles by this author Mark Frydenberg More articles by this author Prokar Dasgupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ductal Adenocarcinoma of the Prostate Gland Treated With Radical Prostatectomy or Radiation Therapy: A Single Institutional Retrospective Review With Long-Term Follow-Up

Ductal adenocarcinoma is a rare variant of prostate cancer considered to be more aggressive than pure acinar adenocarcinoma which often presents at advanced clinical stages in elderly men with urinary symptoms. To better elucidate the behavior of this subtype, we investigated the clinical outcomes of patients who were managed with curative intent. We retrospectively evaluated 31 patients with histologically-confirmed, non-metastatic ductal adenocarcinoma of the prostate who were treated with radical prostatectomy (RP) or radiation therapy (RT) at our institution from 2002-2014. Pathology was required to demonstrate ductal adenocarcinoma in either a pure form or intermixed with acinar elements. Median follow-up was 64.9 months (range: 20.5-174.5 months). 29% of patients presented with significant urinary symptoms including 5 with gross painless hematuria. Median age was 66 (range: 53-80 years) and median pre-treatment PSA was 6.7 (range: 2.3-15.2). Palpable nodularity consistent with cT2 disease was noted in 15 patients; another 15 exhibited clinical T1c exams. Of the cohort, 25 patients underwent RP and 6 patients underwent RT (including 3 patients who received androgen deprivation therapy for at least 6 months). Overall, 15 patients developed biochemical and/or clinical progression and 2 patients died (both from metastatic disease). The RP group accounted for all but one incidences of progression and both deaths. The 5-year/10-year progression-free probability (PFP), prostate-cancer-specific survival (PCSS), and overall survival (OS) rates were 56%/49%, 100%/86%, and 100%/86%. In the RP group, surgical pathology revealed pure ductal type in 7 (28%) patients and mixed ductal/acinar type in 18 (72%) patients. Twelve (48%) patients had pathological tumor classification of pT3a or higher, 11 patients (44%) had post-surgical Gleason score of 8 or higher, and 10 patients (40%) had positive margins. No statistically significant differences were observed between pure type and mixed type in terms of PFS, PCSS, or OS. There was a trend towards pure ductal type presenting in older patients (p=0.07), but no other significant demographic or pathologic differences were found. In the RT group, a high proportion (66%) of patients exhibited pure type, likely secondary to the limitations of biopsy sampling. Notably, the two patients who underwent RP and died from metastatic disease had pure type, pT3b, Gleason 9-10, positive margins, and perineural invasion. In one of the largest single-institution retrospective series of the modern era investigating ductal adenocarcinoma of the prostate treated with curative intent, our data suggest a favorable prognosis comparable to that of pure acinar adenocarcinoma. Although the degree of ductal involvement (pure versus mixed) on pathology was not predictive of outcomes, it may be associated with differences in patient characteristics, especially age.

Advanced prostatic ductal carcinoma in a patient with a long survival time following a total pelvis exenteration: A case report.

Ductal adenocarcinoma of the prostate (DAP) is a rare variant of prostate cancer, and has poorly-identified clinical characteristics. Few cases have been previously reported in Chinese males and DAP is more commonly reported in Caucasian males over 70-years of age. In the present study, a 55-year-old Chinese male patient that demonstrated typical lower urinary tract symptoms and normal prostatic-specific antigen levels underwent a transurethral resection of the prostate. The patient was subsequently diagnosed with DAP. A total pelvis exenteration was then conducted successfully. During the 40-month follow-up, the patient remained progression-free. A review of the literature was conducted in order to assess the clinical course, diagnosis, prognosis and optimal management for DAP. The review indicated that DAP is more likely to demonstrate an aggressive clinical course and an unfavorable prognosis; therefore, once the diagnosis has been confirmed, an aggressive management strategy is recommended for the patient, even in the case of metastatic disease.

Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation

Introduction. Mucinous adenocarcinoma of the prostate is a rare variant of prostate cancer. Its malignant potential and the clinical course of the affected patients remain, by and large, controversial. No data exist about the course of metastatic mucinous adenocarcinoma of the prostate. Case Presentation. This case report describes the excellent clinical course of a 68-year-old patient with metastatic mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, irradiation, and androgen deprivation. Conclusion. In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer. Its malignant potential is dependent on its Gleason score.

Use of irinotecan for treatment of small cell carcinoma of the prostate

Prostatic small cell carcinoma (SCC) is a rare variant of prostate cancer. It is extremely aggressive and resistant to available therapies with a median survival range of 5-17 months. No standard chemotherapeutic regimen has been established for its treatment. In search of a new therapeutic approach, we examined the response of patient-derived prostatic SCC tissue xenografts to irinotecan, a topoisomerase I inhibitor. A tumor tissue line was established from a patient's prostatic SCC by subrenal capsule grafting using NOD-SCID mice. Mice carrying subcutaneous transplants of the tumor line were then treated for 2 weeks with irinotecan alone and in combination with cisplatin. The effect on tumor volume, histopathology, and apoptosis were determined. The prostatic SCC tissue line resembled the donor tissue in morphologic and immunohistochemical features. Irinotecan (20 mg/kg/day; days 1-3, 8-10) completely arrested xenograft growth with a small reduction in tumor volume and only minor weight loss of the hosts (7%); irinotecan (12 mg/kg; same schedule) + cisplatin (2.5 mg/kg/day; days 1 and 8) had a similar effect, but with lower weight loss. While the growth inhibition involved apoptosis, it was also associated with a marked increase in autophagy. Tumor tissue lines established via subrenal capsule xenografting provide models with clinical relevance and the present study suggests that irinotecan could be useful for therapy of refractory prostatic SCC, in particular in combination with cisplatin.

Lymphoepithelioma-like carcinoma of the prostate

In this report, we summarized the clinicopathologic features of 5 cases of lymphoepithelioma-like carcinoma of the prostate, a rare variant of prostate cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. In all 5 patients, there were obstructive symptoms and elevated prostate-specific antigen; one patient had also hematuria. Their ages ranged from 69 to 82 years (mean age, 76 years). The initial diagnosis of lymphoepithelioma-like carcinoma of the prostate was made on transurethral resection in 3 cases and radical prostatectomy in 2 others. In one case the diagnosis of lymphoepithelioma-like carcinoma admixed with conventional acinar adenocarcinoma was an unexpected finding at time of transurethral resection for benign prostatic hyperplasia. Three patients had clinical stage T3 tumors and another had stage T4 disease; stage T1b was present in the remaining case. Microscopically, all tumors contained lymphoepithelioma-like carcinoma, which comprised 10% to 90% of the entire tumor. All cases were associated with adenocarcinoma, either as the sole pattern in 5 cases or with an additional ductal component in 3 cases. One case had additional features of adenosquamous carcinoma. The lymphoepithelioma-like carcinoma component was characterized by indistinct cytoplasmic borders and a syncytial growth pattern. The stroma was densely infiltrated by lymphoid cells admixed with some plasma cells and neutrophils; one case had a prominent infiltration of eosinophils. Immunohistochemical staining demonstrated that lymphoepithelioma-like carcinoma was positive for prostate-specific antigen, prostate acid phosphatase, alpha-methylacyl coenzyme A racemase, and epithelial membrane antigen; several cytokeratins (AE1/AE3, 7, 8, and 20 [rare cells]) were also immunoreactive. The mean Ki-67 labeling index was 53% (range, 40%-70%), and the p53 expression in all cases was low (10%-20%). The lymphoid component was mainly composed of T with a minor subset of B cells, admixed with some dendritic cells and histiocytes as seen by S100 and CD68 immunoreactivity. Latent membrane protein 1 immunostaining and in situ hybridization for Epstein-Barr virus were negative in all 5 lymphoepithelioma-like carcinoma cases. DNA ploidy of lymphoepithelioma-like carcinoma tumors gave DNA histograms with aneuploid peaks. DNA ploidy of the concurrent adenocarcinoma gave DNA aneuploid peaks except in one DNA diploid case. Four patients died of disease from 8 to 26 months; one patient was lost to follow-up. In summary, lymphoepithelioma-like carcinoma of the prostate arise in aggressive prostate cancers at advanced clinical stage. Morphologic recognition and distinction from other prostatic lesions and tumors with prominent lymphoid stroma is critical for its clinical management.

Basal Cell Carcinoma of the Prostate

408 Basal Cell Carcinoma of the Prostate Yun Beom Kim, Yeun Goo Chung, Hee Jae Joo, Woo Seung Lee, Sang Jin Kim, Il Han Kim, Hyun Wook Im, Sun Il Kim, Se Joong Kim From the Departments of Urology and Pathology, Ajou University School of Medicine, Suwon, Korea Basal cell carcinoma (BCC) of the prostate, a rare variant of prostate cancer, is derived from the basal cells of prostatic ducts and acini. BCC generally occurs in elderly men with obstructive voiding symptoms and levels of serum prostate-specific antigen within the normal range. In most cases, diagnosis is made through transurethral resection or simple enucleation. Most cases are indolent, but local recurrence and metastasis have been reported in a few cases. Thus, radical surgery and long-term follow-up are recommended. We report a case of a 54-year-old man who underwent radical retropubic prostatectomy after being diagnosed with BCC during a transurethral resection performed for lower urinary tract symptoms. The patient has remained free of disease for 4 months after surgery. (Korean J Urol 2009;50:408-412) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

A New Case of Signet Ring Cell Carcinoma of the Prostate

Primary signet ring cell carcinoma of the prostate is a very rare variant of prostate cancer. Herein, we report a new case of primary signet ring cell carcinoma of the prostate in an 85-year-old man with voiding disorder and hematuria. Based on this case, we present the anatomopathologic, clinical, and therapeutic aspects of this rare entity.

Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate

Ductal carcinoma of the prostate is a rare variant of prostate cancer that presents most commonly with obstructive urinary symptoms or hematuria. This case series of 6 patients is the first to report the outcome of ductal carcinoma treated with external beam radiotherapy. A retrospective review was performed of patients treated between 1980 and 2006 at Fox Chase Cancer Center, Philadelphia, Penn. Six patients were identified with ductal carcinoma. Five of the 6 patients were treated definitively and the sixth patient was treated at recurrence 3 years after a radical prostatectomy. Patient ages ranged from 66-80 years and the initial prostate-specific antigen (iPSA) ranged from 1.69-100.3 ng/mL. Three patients had a mixed acinar and ductal carcinoma, 2 with a Gleason score (GS) of 8 and 1 with a GS of 7. Of the patients treated definitively, 4 had clinical stage T2A-T2C and 1 had clinical stage T1B. Definitive radiotherapy was delivered to the prostate with doses between 72 Gy and 78 Gy. Pelvic lymph nodes were treated in all patients. One patient was treated postradical prostatectomy to the prostate bed to a dose of 60 Gy. Adjuvant androgen deprivation was given in 5 of the patients. Two of the patients died from metastatic disease at 1.4 and 7.1 years after treatment. The remaining 4 patients remain alive between 3.2 and 4.8 years from treatment, with 3 patients biochemically without evidence of disease. No patients have developed a local recurrence. Ductal carcinoma of the prostate may be treated effectively with external beam radiotherapy. Aggressive management is indicated, even with low-volume metastatic disease.