The presence and clinical implication of intraductal carcinoma of prostate in metastatic castration resistant prostate cancer.
BACKGROUND
Intraductal carcinoma of prostate (IDC-P) is always underestimated pathological pattern in prostate cancer and its role is still unclear in castration resistant prostate cancer (CRPC). This study was conducted to investigate the presence and the roles of IDC-P in patients with metastatic CRPC.


METHODS
45 patients with initially diagnosed metastatic prostate cancer and then progressed to CRPC, were included. All of them were received twice transperineal biopsies at the time of initial diagnosis and the time of CRPC. All samples were retrieved to detect the presence of IDC-P. PSA doubling time (PSADT) was considered as a parameter presenting the progression of CRPC. The relationships between IDC-P and other clinicopathological variables were analyzed.


RESULTS
IDC-P was found only in 20% (9/45) cases at initial diagnosis, whereas, it increased to 62.5% (28/45) at the time of CRPC (χ(2) = 16.568, P = 0.000). Compared to acinar adenocarcinoma components in tumor tissues, IDC-P components, especially solid subtype, had obviously poor/no response to androgen deprivation therapy (ADT). In addition, among patients treated with docetaxel-based chemotherapy (n = 24), patients with IDC-P also showed more unfavorable response than those without IDC-P (20% vs. 66.7%, P = 0.022). The presence of IDC-P and serum testosterone at the time of CRPC, were significantly associated with rapid disease progression. 13/28 (46.4%) CRPC with IDC-P had PSADT less than 30 days, while, only 1/17 (5.9%) patient without IDC-P had a less than 30 days PSADT (χ(2) = 8.114, P = 0.004). Limitations included the relative short follow-up time and a relative small cohort.


CONCLUSIONS
The presence of IDC-P was significantly associated with rapid progression of CRPC. And its presence could suggest the poor response to initial ADT and sequential docetaxel-based chemotherapy. Detection of IDC-P should be of importance in CRPC, and re-biopsy at the time of CRPC might be one of practical solutions. The mechanism of the ADT and docetaxel resistance to IDC-P needed to be further investigated.
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.|Department of Urology, The First people's Hospital of Neijiang, Sichuan, China.
Zhibin
Z
Chen
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Ni
N
Chen
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Pengfei
P
Shen
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Jing
J
Gong
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Xiang
X
Li
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Tao
T
Zhao
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Banghua
B
Liao
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Liangren
L
Liu
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Zhenhua
Z
Liu
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Xingming
X
Zhang
Department of Oncology, West China Hospital, Sichuan University, Chengdu, China.
Jiyan
J
Liu
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Zhufeng
Z
Peng
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Xueqin
X
Chen
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Miao
M
Xu
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Haojun
H
Gui
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Peng
P
Zhang
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Qiang
Q
Wei
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Qiao
Q
Zhou
Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Hao
H
Zeng
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy; D044584:Carcinoma, Ductal / Q000188:drug therapy / Q000473:pathology*; D018450:Disease Progression; D000077143:Docetaxel; D006801:Humans; D015994:Incidence; D007610:Kallikreins / Q000097:blood; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy / Q000473:pathology*; D043823:Taxoids / Q000627:therapeutic use
D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
androgen deprivation therapy resistance; castration resistant prostate cancer; docetaxel resistance; intraductal carcinoma of prostate