title: Ductal adenocarcinoma of the prostate: clinical features and implications after local therapy.
abstract: BACKGROUND
  Ductal or endometrioid adenocarcinoma of the prostate may be a subtype of prostate cancer that is amenable to aggressive local therapeutic strategies. The authors of this report investigated the clinical outcome of patients who had prostate ductal adenocarcinoma after primary radical prostatectomy or radiotherapy.
  
  
  METHODS
  The clinical features of 108 patients with locally confined or advanced prostate ductal adenocarcinoma who had undergone primary radical prostatectomy (surgical group, n = 76 men) or no surgery (nonsurgical group, n = 32 men) were evaluated retrospectively. Clinical records were reviewed, and Gleason scores, clinical/pathologic stages, and preoperative prostate-specific antigen levels were examined. The clinical features that were assessed included local recurrence, distant metastasis, and progression-free and overall survival after primary therapy.
  
  
  RESULTS
  In the surgical group, patients who had pure ductal prostate cancer survived longer (median, 13.8 years; 95% confidence interval [CI], from 13.8 years to not attained) than patients who had mixed ductal prostate cancer (median, 8.9 years; 95% CI, from 7.1 years to not attained; P = .05). In addition, the median time to local progression was shorter (2.8 years vs 4.9 years) and the median time to distant metastasis was longer (3.9 years vs 2.0 years) for patients who had pure ductal adenocarcinoma than for patients who had mixed ductal adenocarcinoma of the prostate after surgery, respectively.
  
  
  CONCLUSIONS
  The results of this preliminary study suggested that pure ductal prostate adenocarcinoma tends to pursue an indolent clinical course and poses an increased risk for local recurrence. Local control (particularly prostatectomy) may improve the clinical outcome of patients with pure prostate ductal adenocarcinoma. These results need to be confirmed in prospective studies.
authors.affiliation: Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. stu@mdanderson.org
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Tu
authors.forename: Adriana
authors.initials: A
authors.lastname: Lopez
authors.forename: Dan
authors.initials: D
authors.lastname: Leibovici
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Bilen
authors.forename: Ferhat
authors.initials: F
authors.lastname: Evliyaoglu
authors.forename: Ana
authors.initials: A
authors.lastname: Aparicio
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Marcy M
authors.initials: MM
authors.lastname: Johnson
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D018450:Disease Progression; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies