Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, Sydney, NSW, Australia.
Clin Oncol (R Coll Radiol). 2019 Feb;31(2):108-114. doi: 10.1016/j.clon.2018.10.011. Epub 2018 Nov 22.
Ductal adenocarcinoma is a rare variant of prostate cancer, and as such clinical outcomes and best management are not well defined. This series demonstrates the atypical presentation and unusual clinical behaviour of ductal adenocarcinoma and proposes management guidelines to assist clinicians.
A retrospective review of pure (nine patients) and mixed (18 patients) ductal adenocarcinoma of the prostate referred to the Departments of Radiation Oncology of the Sydney Cancer Centre, Royal Prince Alfred Hospital and Northern Sydney Cancer Centre, Royal North Shore Hospital, between 2000 and 2015.
Twenty-seven patients were treated with definitive radiotherapy, nine patients (33%) with pure ductal and 18 (67%) with mixed ductal-acinar adenocarcinoma. The median follow-up was 38 months. Four patients (15%) failed locally, all of whom received less than 80 Gy, or no brachytherapy boost. Five patients (19%) failed distantly, four with biopsy-proven lung metastases. All distant failures occurred with a prostate-specific antigen (PSA) < 3 ng/ml.
This series shows the atypical clinical presentation of this entity, as well as its propensity to metastasise to unusual sites. Relapse may occur at low absolute PSA values and is often asymptomatic. Ductal cancer should not simply be regarded as a high Gleason grade cancer. We propose management guidelines, including regular computed tomography examinations (rather than relying solely on PSA levels) as part of the follow-up for patients with any component of ductal adenocarcinoma.
导管腺癌是前列腺癌的一种罕见变异型，因此其临床结果和最佳治疗方法尚未明确。本系列研究展示了导管腺癌的非典型表现和异常临床行为，并提出了管理指南，以协助临床医生。
回顾性分析了 2000 年至 2015 年期间，悉尼癌症中心、皇家阿尔弗雷德王子医院放射肿瘤科和北悉尼癌症中心、皇家北岸医院的纯（9 例）和混合（18 例）导管腺癌患者。
27 例患者接受了根治性放疗，9 例（33%）为纯导管腺癌，18 例（67%）为混合导管腺泡腺癌。中位随访时间为 38 个月。4 例（15%）局部复发，均接受了低于 80 Gy 的放疗，或未行近距离放疗加量。5 例（19%）远处转移，其中 4 例经活检证实为肺转移。所有远处转移均发生于 PSA<3ng/ml。
本研究显示了该实体的非典型临床表现及其向不常见部位转移的倾向。复发可能发生在较低的绝对 PSA 值，且通常无症状。不应单纯将导管癌视为高 Gleason 分级癌症。我们提出了管理指南，包括定期进行计算机断层扫描检查（而不仅仅依赖于 PSA 水平），作为有导管腺癌成分患者随访的一部分。
