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Ductal adenocarcinoma is a rare type of prostate cancer, roughly one case in six hundred, that grows from the larger ducts of the gland rather than from its small acini. It tends to make less PSA than ordinary prostate cancer, so it is found later and more often after it has spread, and it is treated as high-risk disease from the day it is named. Below, week by week, is what OnCo's record of Ductal adenocarcinoma of the prostate says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Germline genetic testing, which the NCCN and the Philadelphia consensus conference recommend for ductal, intraductal or cribriform morphology whatever the stage.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Treated as high-risk prostate cancer: radical prostatectomy or radical radiotherapy with androgen deprivation. No guideline and no randomised trial is specific to ductal histology, and the retrospective comparisons of surgery against radiotherapy are small and inconsistent.
Treated as metastatic acinar prostate cancer, with androgen deprivation and an androgen receptor pathway inhibitor. In the one study that asked the question, 35 ductal cases among 634 men with de novo metastatic prostate cancer had no worse overall or cancer-specific survival than acinar cases, so the histology's disadvantage appears to be in getting to metastasis sooner rather than in behaving worse once there.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.