Pathology Laboratory, Berlin, Germany.
Prostate. 2013 Mar;73(4):442-8. doi: 10.1002/pros.22579. Epub 2012 Sep 4.
Although the term "intraductal carcinoma of the prostate" (IDC-P) was introduced almost 40 years ago, there is still the lack of appreciation that this entity represents a clinically aggressive disease that continues to be misreported under the diagnostic category of high grade prostatic intraepithelial neoplasia (HGPIN).
Recent data obtained from histological, molecular, and clinical studies were reviewed to demonstrate that IDC-P significantly differs from HGPIN, and has a major impact in terms of diagnosis, prognosis and therapy of prostate cancer (PCa).
HGPIN is the only accepted precursor of PCa. Its diagnosis in prostate biopsies has no prognostic implications, and does not dictate therapeutic decisions. By contrast, IDC-P correlates with a worse pathological and clinical outcome. IDC-P differs from HGPIN by distinct histological and molecular features. Recent clinical studies report that IDC-P is associated with neoadjuvant androgen deprivation therapy (ADT) and, chemotherapy (CT) failure as well as early disease recurrence after external beam radiation. Finally, IDC-P is associated with TMPRSS2-ERG gene fusion, which was reported to be regulated by estrogens and their receptors.
IDC-P is an aggressive phenotype of prostate cancer and predicts poor response to ADT, CT, and external beam radiation. IDC-P should be separated from HGPIN and should be reported in prostate biopsies and prostatectomy specimens.
尽管“前列腺导管内癌”（IDC-P）这一术语在近 40 年前就已提出，但人们仍然没有意识到，这种实体代表了一种临床上具有侵袭性的疾病，它仍在被错误地归类为高级别前列腺上皮内瘤变（HGPIN）。
回顾了来自组织学、分子和临床研究的最新数据，以证明 IDC-P 与 HGPIN 显著不同，并且在前列腺癌（PCa）的诊断、预后和治疗方面具有重大影响。
HGPIN 是 PCa 的唯一公认前体。在前列腺活检中诊断 HGPIN 没有预后意义，也不会决定治疗决策。相比之下，IDC-P 与更差的病理和临床结果相关。IDC-P 在组织学和分子特征上与 HGPIN 不同。最近的临床研究报告称，IDC-P 与新辅助雄激素剥夺治疗（ADT）和化疗（CT）失败以及外照射后早期疾病复发相关。最后，IDC-P 与 TMPRSS2-ERG 基因融合相关，据报道该融合受雌激素及其受体调控。
IDC-P 是前列腺癌的一种侵袭性表型，预示着对 ADT、CT 和外照射的反应不佳。IDC-P 应与 HGPIN 分开，并应在前列腺活检和前列腺切除标本中报告。
