title: Contemporary Population-Based Comparison of Localized Ductal Adenocarcinoma and High-Risk Acinar Adenocarcinoma of the Prostate.
abstract: OBJECTIVE
  To compare pathological characteristics, treatment patterns, and survival in patients with ductal adenocarcinoma (DC) compared to those with acinar adenocarcinoma (AC).
  
  
  METHODS
  Using the National Cancer Database, we identified patients diagnosed with clinically localized (cN0, cM0) pure DC (n = 1328) and AC (n = 751,635) between 1998 and 2011. High-risk AC was defined as Gleason 8-10. Demographic, treatment, pathological, and survival characteristics of patients were compared.
  
  
  RESULTS
  Compared to patients with Gleason 8-10 AC, those with DC presented with lower mean prostate-specific antigen (10.3 vs 16.2 ng/mL, P <.001), had similar rates (11.7% vs 11.5%, P = .8) of clinical extra-capsular extension (stage ≥ cT3), and were more likely to undergo prostatectomy (54% vs 36%, P <.001). Compared to patients with Gleason 8-10 AC undergoing prostatectomy, those with DC had more favorable pathology: stage ≥ T3 (39% vs 52%, P <.001), fewer positive lymph nodes (4% vs 11%, P <.001), and fewer positive margins (25% vs 33%, P <.001). On Kaplan-Meier analysis, patients with DC had similar 5-year survival (75.0%, 95% confidence interval [CI] [71.7-78.9]) compared to those with Gleason 8-10 AC (77.1%, 95% CI [76.6%-77.6%], P = .2). On Cox multivariable analysis, patients with Gleason 8-10 AC had a similar risk of death compared to those with DC (hazards ratio = 0.92, 95% CI [0.69-1.23], P = 6).
  
  
  CONCLUSIONS
  In this large contemporary population-based series, patients with DC of the prostate presented with lower prostate-specific antigen, had more favorable pathological features, and similar overall survival compared to men with Gleason 8-10 AC.
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL. Electronic address: vignesh.packiam@uchospitals.edu.
authors.forename: Vignesh T
authors.initials: VT
authors.lastname: Packiam
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Department of Urology, University of Wisconsin-Madison, Madison, WI.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Weiner
authors.affiliation: Department of Pathology, University of Chicago, Chicago, IL.
authors.forename: Gladell P
authors.initials: GP
authors.lastname: Paner
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: David J
authors.initials: DJ
authors.lastname: VanderWeele
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Zagaja
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D000368:Aged; D001706:Biopsy; D018267:Carcinoma, Acinar Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D044584:Carcinoma, Ductal / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D008297:Male; D060787:Neoplasm Grading; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology