title: Heterogeneous clinicopathological features of intraductal carcinoma of the prostate: a comparison between "precursor-like" and "regular type" lesions.
abstract: Intraductal carcinoma of the prostate (IDC-P) has been described as a lesion associated with intraductal spread of invasive carcinoma and consequently aggressive disease. However, there are a few reported cases of pure IDC-P without an associated invasive component, strongly suggesting that this subset of IDC-P may represent a precursor lesion. We compared the clinicopathological features between the morphologically "regular type" IDC-P and "precursor-like" IDC-P. IDC-P was defined as follows; 1) solid/dense cribriform lesions or 2) loose cribriform/micropapillary lesions with prominent nuclear pleomorphism and/or non-focal comedonecrosis. We defined precursor-like IDC-P as follows; 1) IDC-P without adjoining invasive adenocarcinoma but carcinoma present distant from the IDC-P or 2) IDC-P having adjoining invasive microcarcinoma (less than 0.05 ml) and showing a morphologic transition from high-grade prostatic intraepithelial neoplasia (HGPIN) to the IDC-P. IDC-P lacking the features of precursor-like IDC-P was categorized as regular type IDC-P. Of 901 radical prostatectomies performed at our hospital, 141 and 14 showed regular type IDC-P and precursor-like IDC-P in whole-mounted specimens, respectively. Regular type IDC-P cases had significantly higher Gleason score, more frequent extraprostatic extension and seminal vesicle invasion, more advanced pathological T stage, and lower 5-year biochemical recurrence-free rate than precursor-like IDC-P cases. Multivariate analysis revealed nodal metastasis and the presence of regular type IDC-P as independent predictors for biochemical recurrence. Our data suggest that IDC-P may be heterogeneous with variable clinicopathological features. We also suggest that not all IDC-P cases represent intraductal spread of pre-existing invasive cancer, and a subset of IDC-P may be a precursor lesion.
authors: Department of Pathology and Genomic Medicine, Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Kosuke
authors: K
authors: Miyai
authors: Department of Pathology and Genomic Medicine, Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Mukul K
authors: MK
authors: Divatia
authors: Department of Pathology and Genomic Medicine, Weill Cornell Medical College of Cornell University Houston, TX, USA ; Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Steven S
authors: SS
authors: Shen
authors: Department of Urology, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Brian J
authors: BJ
authors: Miles
authors: Department of Pathology and Genomic Medicine, Weill Cornell Medical College of Cornell University Houston, TX, USA ; Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Alberto G
authors: AG
authors: Ayala
authors: Department of Pathology and Genomic Medicine, Weill Cornell Medical College of Cornell University Houston, TX, USA ; Weill Cornell Medical College of Cornell University Houston, TX, USA.
authors: Jae Y
authors: JY
authors: Ro
mesh_terms: D000368:Aged; D001706:Biopsy; D044584:Carcinoma, Ductal / Q000097:blood / Q000737:chemistry / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000097:blood / Q000737:chemistry / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D019048:Prostatic Intraepithelial Neoplasia / Q000097:blood / Q000737:chemistry / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000097:blood / Q000737:chemistry / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Prostate; high-grade prostatic intraepithelial neoplasia; intraductal carcinoma of prostate