Kryvenko Oleksandr N, Punnen Sanoj, Udayakumar Thirupandiyur S, Gaston Sandra M, Tao Wensi, Ma Wendi, Stoyanova Radka, Pollack Alan
Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Int J Surg Pathol. 2023 Apr;31(2):184-189. doi: 10.1177/10668969221098080. Epub 2022 May 6.
Historically, intraductal carcinoma of the prostate (IDC-P) was postulated to be a retrograde spread of high-grade invasive prostate cancer. There is evidence that IDC-P can primarily originate in the prostatic ducts. The retrograde genesis has never been experimentally or clinically confirmed before. Biopsy proven intermediate or high-risk prostate cancer was orthotopically grafted in the prostate of severe combined immunodeficiency gamma mice. Cancer growth was monitored by serum PSA levels. The animals were sacrificed and grafted areas were histological examined. Twenty-one of 23 mice survived and demonstrated rising serum PSA. In 10 of 21 animals, human prostate cancer was identified orthotopically. Except for one case where the human biopsy showed a Grade Group 2 prostate cancer and mouse graft was Grade Group 5, other 9 specimens showed comparable grades. One of the specimens demonstrated a cribriform invasive prostate cancer and adjacent IDC-P. These experimental data offer some evidence that invasive prostate cancer can demonstrate a retrograde spread in the prostatic ducts as IDC-P. Its ability to primarily arise in the ducts has been demonstrated in other studies. However, the issue which remains unresolved is in its most common presentation of IDC-P intermixed with high-grade invasive cancer if it is the former or the latter which came first. Possibly resolving this dilemma will shed some light on the existing controversies if IDC-P should or should not be graded when invasive cancer is present.
从历史上看，前列腺导管内癌（IDC-P）被推测为高级别浸润性前列腺癌的逆行扩散。有证据表明，IDC-P可原发于前列腺导管。此前，逆行起源从未在实验或临床上得到证实。将活检证实的中危或高危前列腺癌原位移植到重度联合免疫缺陷γ小鼠的前列腺中。通过血清前列腺特异性抗原（PSA）水平监测肿瘤生长。处死动物后，对移植部位进行组织学检查。23只小鼠中有21只存活，血清PSA水平升高。在21只动物中的10只中，原位发现了人类前列腺癌。除1例人类活检显示为2级前列腺癌而小鼠移植瘤为5级外，其他9个标本的分级相当。其中1个标本显示筛状浸润性前列腺癌及相邻的IDC-P。这些实验数据提供了一些证据，表明浸润性前列腺癌可作为IDC-P在前列腺导管内发生逆行扩散。其原发于导管的能力在其他研究中已得到证实。然而，尚未解决的问题是，在IDC-P最常见的与高级别浸润性癌混合出现的情况下，究竟是前者还是后者先出现。如果存在浸润性癌时IDC-P是否应该分级，解决这一困境可能会为现有争议提供一些线索。
