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Intraductal carcinoma of the prostate (IDC-P) is considered both a distinct entity (found alone in ~3% of prostate biopsies) and negative prognostic factor of prostatic cancer (identified in ~20% of all patients with prostate cancer). Current National Comprehensive Cancer Network¯ (NCCN¯) guidelines for all patients with prostate cancer recommend either radiotherapy (RT) or radical prostatectomy (RP) as initial treatment in the context of patient risk and life expectancy. Given the mortality and rarity of this disease, we analyzed treatment trends of patients diagnosed with IDC-P in the US. A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database sponsored by the National Cancer Institute (NCI) was conducted for patients with a diagnosis of IDC-P between 2000 and 2018. Univariate and multivariate survival analyses were performed using 95% confidence intervals [CI] and a P value < 0.05 indicating significance. Four hundred twenty-three patients with complete survival, staging, and treatment information were identified. 32% received only RT (10% underwent brachytherapy and 90% received external beam RT (EBRT)), 56% underwent RP, and 8% received both. On multivariate Cox regression analysis, RP improved OS compared to RT (p<0.001). Stratifying by stage, patients with local IDC-P treated with RT only had decreased five-year overall survival (5y OS) compared to those that underwent RP only (72% vs 98%; p<0.001); this did not hold for patients with regional disease (p = 0.790). This trend remained true upon comparison of patients either <65 years or ≥65 years at diagnosis (see Table 1). 5y OS for patients that underwent RP solely was non-inferior to patients that received adjuvant RT after RP in those with either local or regional disease (p = 0.513 and 0.491, respectively). No difference was seen in 5y OS regarding modality of RT for patients with local or regional disease (p = 0.194 and 0.285, respectively). Proportional analysis of treatment stratified by race revealed White patients were more likely than Asian (7% of cohort) or Black (11% of cohort) patients to receive RP with adjuvant RT, while Black patients were most likely to undergo RP alone (Likelihood Ratio = 12.4; p = 0.054). This analysis found RP for IDC-P to offer survival benefit compared to RT and was non-inferior to RP with adjuvant EBRT for patients with local disease; this trend remained true among patients either <65 years or ≥65 years at diagnosis. No difference in survival was seen between EBRT or brachytherapy among patients treated with RT only. Differences in rates of RP and RT may exist with respect to race. Further investigation of regional differences and the impact of chemotherapy on outcomes for patients with ICD-P is warranted. [ABSTRACT FROM AUTHOR]

Context: The recent increase in ability to diagnose prostatic adenocarcinoma has created a dilemma for treatment decisions.Objective: To determine whether prostate cancer progression is associated with a modified version of the Gleason grading system together with selected morphologic and clinical variables.Design: Retrospective analysis of a cohort of patients with peripheral zone prostate cancers who underwent surgery between August 1983 and July 1992.Setting: University hospital.Patients: Radical prostatectomy specimens from 379 men treated only by surgical excision were prospectively studied for 8 morphologic variables using previously standardized techniques. Variables were percentage of each cancer occupied by Gleason grade 4/5 (% Gleason grade 4/5, the Stanford modified Gleason scale), cancer volume, vascular invasion, lymph node involvement, seminal vesicle invasion, capsular penetration, positive surgical margin, prostate weight, and preoperative prostate-specific antigen (PSA) level.Main Outcome Measure: Biochemical progression of prostate cancer as indicated by serum PSA level of 0.07 ng/mL and increasing.Results: Cancer grade expressed as % Gleason grade 4/5 and cancer volume were highly predictive of disease progression. In a Cox proportional hazards model that included % Gleason grade 4/5, the traditional Gleason score was not an independent predictor of treatment failure. Positive lymph node findings and intraprostatic vascular invasion were the only other variables that remained significant at the .01 level.Conclusion: The % Gleason grade 4/5, cancer volume, positive lymph node findings, and intraprostatic vascular invasion were independently associated with prostate cancer progression, defined by an increasing PSA level. Techniques to accurately measure cancer volume and % Gleason grade 4/5 are needed to better predict which patient will experience cancer progression. The commonly accepted predictors of progression-capsular penetration and positive surgical margins-were not independently predictive of failure after radical prostatectomy. [ABSTRACT FROM AUTHOR]