Aquesta Pathology, Brisbane, Queensland, 4064 Australia.
Hum Pathol. 2010 Feb;41(2):281-5. doi: 10.1016/j.humpath.2009.08.010. Epub 2009 Dec 11.
Ductal adenocarcinoma of the prostate is an aggressive malignancy, often presenting at an advanced stage. In mixed ductal and acinar adenocarcinomas, the relationship between the proportion of the ductal component of the tumor and the pathologic stage and whether or not aggressive behavior is simply a function of grade remains undetermined. From 268 consecutive radical prostatectomies undertaken as a curative procedure for clinical localized prostate cancer, we identified 34 cases (12.7%) with ductal adenocarcinoma of the prostate comprising 5% to 100% of the total tumor volume. For cases with a ductal adenocarcinoma of the prostate component, the mean age at diagnosis of 60 years (range 49-69 years), mean serum prostate-specific antigen of 8.4 ng/mL (range, 0.8-21 ng/mL) and positive surgical margin rate of 17.6% did not differ significantly from that of the pure adenocarcinoma group. All 34 patients with ductal adenocarcinoma of the prostate had peripheral zone involvement while 16 (46%) also had transition zone involvement. Twenty-five (73%) cases with ductal adenocarcinoma of the prostate had extraprostatic extension (pT3), which compared to 32.9% with acinar adenocarcinoma. The presence of ductal adenocarcinoma of the prostate (P < .0001), high tumor volume (P = .001) and Gleason score >7 (P = .04) significantly predicted pT3 staging category, and the presence of ductal adenocarcinoma of the prostate remained a significant predictor for pT3, after adjusting for tumor volume and Gleason score >7. The proportion of ductal adenocarcinoma of the prostate did not significantly modify the strength of the observed association with pathological stage. In view of the significant association with extraprostatic extension we would recommend that in both core biopsies and radical prostatectomy specimens any proportion of ductal adenocarcinoma of the prostate should be reported.
前列腺导管腺癌是一种侵袭性恶性肿瘤，常表现为晚期。在混合性导管和腺泡性腺癌中，肿瘤导管成分的比例与病理分期之间的关系，以及侵袭性行为是否仅仅是分级的函数，仍未确定。在 268 例连续接受根治性前列腺切除术治疗临床局限性前列腺癌的患者中，我们发现 34 例（12.7%）前列腺导管腺癌占肿瘤总体积的 5%至 100%。对于有前列腺导管腺癌成分的病例，诊断时的平均年龄为 60 岁（范围为 49-69 岁），平均血清前列腺特异性抗原为 8.4ng/ml（范围为 0.8-21ng/ml），切缘阳性率为 17.6%，与纯腺癌组无显著差异。34 例前列腺导管腺癌患者均有外周区受累，16 例（46%）患者同时有移行区受累。25 例（73%）有前列腺导管腺癌的病例有前列腺外侵犯（pT3），而有腺泡腺癌的病例为 32.9%。有前列腺导管腺癌（P<.0001）、肿瘤体积大（P=0.001）和 Gleason 评分>7（P=0.04）显著预测 pT3 分期，在调整肿瘤体积和 Gleason 评分>7 后，有前列腺导管腺癌仍然是 pT3 的显著预测因素。前列腺导管腺癌的比例并没有显著改变与病理分期的观察关联强度。鉴于与前列腺外侵犯的显著关联，我们建议在核心活检和根治性前列腺切除标本中，无论导管腺癌的比例如何，都应报告。
