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Does prostatic ductal adenocarcinoma exist?

B J Bock¹, D G Bostwick

¹Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.

The American Journal of Surgical Pathology

|July 14, 1999

Summary

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Prostate cancer with ductal features, like papillary or cribriform patterns, often originates in the peripheral zone, not the periurethral ducts. These features in needle biopsies typically indicate peripheral zone adenocarcinoma, not distinct ductal adenocarcinoma.

Area of Science:

Uropathology
Surgical Pathology
Oncology

Background:

Prostatic ductal (endometrioid) adenocarcinoma is a debated entity due to histologic overlap with acinar adenocarcinoma.
Conflicting views exist regarding the distinct clinical behavior of ductal adenocarcinoma.
Peripheral zone prostate cancers can exhibit papillary or cribriform patterns.

Purpose of the Study:

To determine the incidence of "ductal features" (papillary or cribriform patterns) in non-ductal prostate carcinoma.
To investigate the origin and characteristics of prostate cancers displaying ductal features.
To clarify the relationship between ductal adenocarcinoma and acinar adenocarcinoma.

Main Methods:

Reviewed 338 whole-mount prostatectomy specimens with acinar carcinoma.

Related Experiment Videos

Defined "ductal features" as papillary or cribriform patterns in foci ≥5 mm.

Used anti-keratin 34beta-E12 immunohistochemistry to exclude high-grade prostatic intraepithelial neoplasia.

Main Results:

Carcinoma with ductal features was identified in 5% of cases (17/338), exclusively in the peripheral zone.
Papillary pattern occurred in 65% and cribriform pattern in 59% of these cases.
Focal papillary or cribriform patterns were present in 36% of available needle biopsies from these cases.

Conclusions:

Peripheral zone prostate adenocarcinoma can exhibit features classically associated with ductal adenocarcinoma.
Prostatic ductal adenocarcinoma may represent spread of acinar carcinoma into periurethral ducts.
Histologic features like papillary or cribriform growth in needle biopsies usually indicate peripheral zone adenocarcinoma, not a distinct ductal type.