Dados do Trabalho

Título

PROSTATIC DUCTAL ADENOCARCINOMA AND COMPARISON TO HIGH-RISK ACINAR ADENOCARCINOMA OF THE PROSTATE IN PATIENTS UNDERGOING ROBOTIC RADICAL PROSTATECTOMY (RARP): A PROSTATE CANCER REFERRAL CENTRE REVIEW

Resumo

Introduction & Objectives
Ductal adenocarcinoma (DAC) is the second most common pathological subtype of prostate cancer (next to acinar adenocarcinoma) and maybe more aggressive with worse oncological outcomes. The objective of this study is to compare the oncological outcomes of patients with DAC to those high-risk acinar adenocarcinoma (AAC) who underwent RARP.

Materials & Methods
A retrospective review of all patients undergoing an RARP from 2008 to 2023 was undertaken with the identification of all patients with histologically verified DAC and high-risk AAC, based on the D'Amico Risk Classification for prostate cancer. The primary outcome of this study was the overall survival rate of patients with DAC compared to patients with high-risk AAC. Secondary outcomes were between-group differences in the proportion of patients with biochemical persistence and biochemical recurrence (BCR).

Results

Patients
Out of the 15,026 patients who underwent RARP during the specified time frame, 617 patients (4.1%) were confirmed to have histologically verified DAC of the prostate, and 2,913 patients (19.4%) were determined to have high-risk AAC. Both groups had a median age of 65 years. However, the DAC group exhibited significantly lower median PSA levels (5.6 ng/mL vs. 7.2 ng/mL, p-value < 0.001) and PSA density (0.105 vs. 0.141 ng/mL^2, p-value < 0.001) when compared to the high-risk AAC group. Additionally, the DAC group had a higher proportion of patients with a family history of prostate cancer (38.8% vs. 31.5%, OR = 1.38). Conversely, the high-risk AAC group had a higher proportion of patients with a history of smoking (35.1% vs. 26.0%, OR = 1.18, p-value = 0.045).

Outcomes
The median follow-up time was 5 years. Compared to the high-risk AAC and DAC groups, all-cause mortality was higher in the high-risk AAC group (3.7% vs. 2.1%, OR = 1.66, p = 0.03). Furthermore, the high-risk AAC group exhibited a higher proportion of patients experiencing biochemical persistence (13.0% vs. 4.1%, OR = 3.0, p-value < 0.001) and biochemical recurrence (BCR) (22.8% vs. 14.9%, OR = 1.56, p-value < 0.001) in contrast to the DAC group.

Conclusion
DAC is an uncommon subtype of prostate cancer on final pathology following RARP. Although, there appear to be differences in baseline characteristics in patients with DAC compared to high-risk AAC, however, patients with high-risk AAC in our study had higher rates of all-cause mortality, biochemical persistence, and BCR when compared to DAC.