Ductal adenocarcinoma of the prostate
Prepared with OnCo (onco.cc/prep/prostate-ductal-adenocarcinoma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
8 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Ductal morphology on the report: more than 50 percent ductal at prostatectomy, or 'adenocarcinoma with ductal features' on a needle biopsy, PSA, read with caution because ductal disease makes less of it for the same tumour burden, Germline and somatic homologous recombination and mismatch repair genes, tested because ductal morphology is one of the triggers), and what were the results?
- 3.Is germline (inherited) genetic testing recommended for me or my family?
- 4.For my situation (localised), which of the standard options do you recommend and why?
- 5.For my situation (any stage, at diagnosis), which of the standard options do you recommend and why?
- 6.For my situation (metastatic), which of the standard options do you recommend and why?
- 7.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 8.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
The words I may hear
- Radical prostatectomy: Removing the entire prostate gland and seminal vesicles for localised prostate cancer, now almost always with a robot.
- Acinar adenocarcinoma of the prostate: The ordinary type of prostate cancer, more than 95 in every 100 cases.
- Gleason score / Grade Group: The pathologist's 1-to-5 grade of how abnormal prostate cancer looks, which drives most treatment decisions.
- Intraductal carcinoma of the prostate (IDC-P): Cancer cells filling prostate ducts and acini that still have their own outer basal cell layer.
- Cribriform growth pattern in prostate cancer: A sieve-like growth pattern inside prostate cancer, named for the holes punched through a sheet of tumour cells.
- PSA (prostate-specific antigen): A blood protein made by the prostate; raised levels prompt further tests, and falling levels show treatment is working.
- Cambridge Prognostic Group (CPG 1 to 5): The five-band risk score the NHS uses for prostate cancer that has not spread.
- TNM staging for prostate cancer, and what changed in the 9th edition: The anatomical stage of prostate cancer: how far the tumour has grown (T), whether it is in the pelvic lymph nodes (N) and whether it has spread further (M).
Tests and results to bring
Any stage, at diagnosis: Germline genetic testing, which the NCCN and the Philadelphia consensus conference recommend for ductal, intraductal or cribriform morphology whatever the stage.
Biomarker results to ask for: Ductal morphology on the report: more than 50 percent ductal at prostatectomy, or 'adenocarcinoma with ductal features' on a needle biopsy, PSA, read with caution because ductal disease makes less of it for the same tumour burden, Germline and somatic homologous recombination and mismatch repair genes, tested because ductal morphology is one of the triggers.
Scans and tests linked to this cancer: Germline (hereditary) testing, Histopathology & immunohistochemistry, Multiparametric prostate MRI (PI-RADS), PSMA PET.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Localised: 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. (Robotic & minimally invasive surgery, IMRT / IGRT (modern external beam), Androgen deprivation & AR pathway inhibitors, Radical prostatectomy)
- Metastatic: 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. (Androgen deprivation & AR pathway inhibitors, PSMA PET)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.