MRI Finding of Prostatic Ductal Adenocarcinoma

Ductal adenocarcinoma is a variant of prostatic adenocarcinoma, originating from the epithelial lining of the primary and secondary ducts of the prostate. We report a 63-year-old male with prostatic ductal adenocarcinoma, presenting as urinary retention and a prostate-specific antigen (PSA) level of 11.71 ng/mL and biopsy-proven prostate cancer (Gleason score 3 + 3). MRI showed 2 hemorrhagic, multilocular cysts projecting into the bladder side from the prostatic inner gland and between the prostate and the right seminal vesicle. The prostate inner gland showed high signal intensity on the T2-weighted image and included tiny hyperintense spots on the fat-suppression T1-weighted image. In the part of the border of the hemorrhagic, multilocular cyst, a solid portion showing slight low intensity on T1-weigthed imaging and markedly restricted diffusion was observed, suggesting prostate cancer. He underwent total prostatectomy, and ductal adenocarcinoma (Gleason score 4 + 4) in the prostate inner gland and multilocular cysts was pathologically diagnosed. After the operation, his PSA level gradually increased, and MRI 8 months after the operation showed a vesical multilocular cyst, suggesting local recurrence. After he underwent radiation therapy and hormonal therapy, PSA level decreased, and no re-recurrence was observed during 8 years. We suggest its inclusion in the differential diagnosis of cases of prostatic ductal adenocarcinoma’s multiloculated cystic formation around the prostate and the bladder.

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Customized Tool for the Validation of Optical Coherence Tomography in Differentiation of Prostate Cancer

Technology in Cancer Research & Treatment ◽

10.1177/1533034615626614 ◽

2016 ◽

Vol 16 (1) ◽

pp. 57-65 ◽

Cited By ~ 8

Author(s):

B. G. Muller ◽

A. Swaan ◽

D. M. de Bruin ◽

W. van den Bos ◽

A. W. Schreurs ◽

...

Keyword(s):

Prostate Cancer ◽

Optical Coherence Tomography ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Optical Coherence ◽

Fresh Tissue ◽

3 Dimensional ◽

Whole Mount ◽

The Right

Objective: To design and demonstrate a customized tool to generate histologic sections of the prostate that directly correlate with needle-based optical coherence tomography pullback measurements. Materials and Methods: A customized tool was created to hold the prostatectomy specimens during optical coherence tomography measurements and formalin fixation. Using the tool, the prostate could be sliced into slices of 4 mm thickness through the optical coherence tomography measurement trajectory. In this way, whole-mount pathology slides were produced in exactly the same location as the optical coherence tomography measurements were performed. Full 3-dimensional optical coherence tomography pullbacks were fused with the histopathology slides using the 3-dimensional imaging software AMIRA, and images were compared. Results: A radical prostatectomy was performed in a patient (age: 68 years, prostate-specific antigen: 6.0 ng/mL) with Gleason score 3 + 4 = 7 in 2/5 biopsy cores on the left side (15%) and Gleason score 3 + 4 = 7 in 1/5 biopsy cores on the right side (5%). Histopathology after radical prostatectomy showed an anterior located pT2cNx adenocarcinoma (Gleason score 3 + 4 = 7). Histopathological prostate slides were produced using the customized tool for optical coherence tomography measurements, fixation, and slicing of the prostate specimens. These slides correlated exactly with the optical coherence tomography images. Various structures, for example, Gleason 3 + 4 prostate cancer, stroma, healthy glands, and cystic atrophy with septae, could be identified both on optical coherence tomography and on the histopathological prostate slides. Conclusion: We successfully designed and applied a customized tool to process radical prostatectomy specimens to improve the coregistration of whole mount histology sections to fresh tissue optical coherence tomography pullback measurements. This technique will be crucial in validating the results of optical coherence tomography imaging studies with histology and can easily be applied in other solid tissues as well, for example, lung, kidney, breast, and liver. This will help improve the efficacy of optical coherence tomography in cancer detection and staging in solid organs.

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Pre-treatment risk stratification of prostate cancer patients:A critical review

Canadian Urological Association Journal ◽

10.5489/cuaj.148 ◽

2012 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

George Rodrigues ◽

Padraig Warde ◽

Tom Pickles ◽

Juanita Crook ◽

Michael Brundage ◽

...

Keyword(s):

Prostate Cancer ◽

Prognostic Factors ◽

Cancer Risk ◽

Risk Stratification ◽

Gleason Score ◽

Critical Review ◽

Specific Antigen ◽

Prostate Cancer Risk ◽

Original Research ◽

Pre Treatment

Introduction: The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and highintermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.

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Prostatic ductal adenocarcinoma: an unusual case of a rare prostate cancer

Journal of Solid Tumors ◽

10.5430/jst.v9n2p28 ◽

2019 ◽

Vol 9 (2) ◽

pp. 28

Author(s):

Rayan El Hassan ◽

John Corr ◽

Rajiv Pillai

Keyword(s):

Locally Advanced ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Ductal Adenocarcinoma ◽

Flexible Cystoscopy ◽

Open Radical Prostatectomy ◽

Adenocarcinoma Of The Prostate ◽

Papillary Lesions ◽

Magnetic Resonance Imaging Mri ◽

The Right

A 65 year old gentleman was referred with symptoms of haematuria and haematospermia in association with an elevated prostate specific antigen (PSA). He was investigated with a flexible cystoscopy, Ultrasound scan and a computed tomography (CT) of his abdomen and pelvis. These failed to reveal any abnormality. Magnetic resonance imaging (MRI) revealed a Prostate Imaging Reporting and Data System PIRADS 2 lesion in the left peripheral gland and PIRADS 3 lesion on the right side posterolaterally at the level of mid gland of the prostate. He went on to have Transrectal ultrasound biopsies of his prostate (TRUS Bx) that excluded any pathology. On follow up visits his PSA continued to rise and he underwent Template biopsies of the prostate. The histological features had no evidence of any Prostatic intraepithelial carcinoma (PIN) or other malignancies. Flexible cystoscopy was repeated due to his persistent haematospermia. This showed prominent papillary lesions over his verumontanum and prostatic urethra. Biopsies from these areas revealed Ductal Adenocarcinoma of the Prostate (DACP). A subsequent staging MRI revealed unchanged appearance of the PIRADS2 nodule. There was however some low signal extending into the right seminal vesicle which is more pronounced than on the previous scan reported as PIRADS3. Subsequent mapping Template biopsies and Transurethral biopsies revealed a Gleason 4+4 DCAP. A staging CT and bone scan excluded any metastasis. He went on to receive an open radical prostatectomy and pelvic lymph node dissection as a curative treatment for his locally advanced disease.

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Case 1.9

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0009 ◽

2014 ◽

pp. 17-18

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Signal Intensity ◽

High Signal Intensity ◽

Focal Lesion ◽

High Signal ◽

Diffusion Weighted Image ◽

Kidney Donor ◽

Weighted Image ◽

Hepatic Lobe ◽

Adc Map ◽

The Right

63-year-old female potential kidney donor with an indeterminate liver mass Axial fat-suppressed FSE T2-weighted (Figure 1.9.1) and SSFP (Figure 1.9.2) images demonstrate a focal lesion with high signal intensity in the right hepatic lobe. Diffusion-weighted image (b=600 s/mm2) and corresponding ADC map (...

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Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.270 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 93 ◽

Cited By ~ 12

Author(s):

Stavros Sfoungaristos ◽

Petros Perimenis

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Prostate Volume ◽

Specific Antigen ◽

Secondary Analysis ◽

Intraepithelial Neoplasia ◽

Treatment Modalities ◽

Psa Density ◽

Group 2

Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy.Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2).Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively.Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned.

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Evaluation of Plasma Circulating Cell Free DNA Concentration and Integrity in Patients with Prostate Cancer in Jamaica: A Preliminary Study

Diseases ◽

10.3390/diseases8030034 ◽

2020 ◽

Vol 8 (3) ◽

pp. 34

Author(s):

Andrew Condappa ◽

Donovan McGrowder ◽

William Aiken ◽

Wayne McLaughlin ◽

Maxine Gossell-Williams

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Quantitative Polymerase Chain Reaction ◽

Specific Antigen ◽

Total Prostate Specific Antigen ◽

Noninvasive Biomarker ◽

Preliminary Study ◽

Polymerase Chain ◽

Free Circulating Dna ◽

Total Psa

Background: Cell free circulating DNA (cfcDNA) is a promising diagnostic tool for prostate cancer (PCa). This study aimed to measure the cfcDNA concentration and integrity in PCa patients using quantitative polymerase chain reaction (qPCR) analysis. This study also assessed the correlation between these molecular biomarkers with total prostate-specific antigen (PSA), Gleason score, prostate volume, and age. Methods: Eleven PCa patients and 9 persons with benign prostatic hyperplasia (BPH) were recruited. Blood samples were collected before prostate biopsy and plasma quantified by qPCR amplification of the ALU 115 DNA sequence, with the ratio of ALU 247 to ALU 115 reflecting cfcDNA integrity. Results: There were no significant differences in median, interquartile range (IQR) cfcDNA concentration or cfcDNA integrity between the patients with PCa (47.9 (214.93) ng/mL; 0.61 (0.49)) and persons with BPH (41.5 (55.13) ng/mL, p = 0.382; 0.67 (0.45), p = 0.342). A weakly positive correlation exists between cfcDNA concentration and total PSA (r = 0.200, p = 0.555) but not with age or Gleason score in PCa patients. Conclusion: cfcDNA concentration was relatively nonsignificantly higher in PCa patients in comparison to persons with BPH, whereas cfcDNA integrity was similar in both groups. Though limited in sample size, this study shows that cfcDNA concentration may be a potentially valuable noninvasive biomarker for the diagnosis of PCa.

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ETS-related gene(ERG) expression as a predictor of oncological outcomes in patients with high-grade prostate cancer treated with primary androgen deprivation therapy: a cohort study

BMJ Open ◽

10.1136/bmjopen-2018-025161 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025161

Author(s):

Mark Rezk ◽

Ashish Chandra ◽

Daniel Addis ◽

Henrik Møller ◽

Mina Youssef ◽

...

Keyword(s):

Prostate Cancer ◽

Cohort Study ◽

Prostate Specific Antigen ◽

Outcome Measures ◽

Androgen Deprivation Therapy ◽

Gleason Score ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Androgen Deprivation ◽

Related Gene

ObjectivesTo determine whetherETS-related gene(ERG) expression can be used as a biomarker to predict biochemical recurrence and prostate cancer-specific death in patients with high Gleason grade prostate cancer treated with androgen deprivation therapy (ADT) as monotherapy.MethodsA multicentre retrospective cohort study identifying 149 patients treated with primary ADT for metastatic or non-metastatic prostate cancer with Gleason score 8–10 between 1999 and 2006. Patients planned for adjuvant radiotherapy at diagnosis were excluded. Age at diagnosis, ethnicity, prostate-specific antigen and Charlson-comorbidity score were recorded. Prostatic tissue acquired at biopsy or transurethral resection surgery was assessed for immunohistochemical expression ofERG. Failure of ADT defined as prostate specific antigen nadir +2. Vital status and death certification data determined using the UK National Cancer Registry. Primary outcome measures were overall survival (OS) and prostate cancer specific survival (CSS). Secondary outcome was biochemical recurrence-free survival (BRFS).ResultsThe median OS of our cohort was 60.2 months (CI 52.0 to 68.3).ERGexpression observed in 51/149 cases (34%). Multivariate Cox proportional hazards analysis showed no significant association betweenERGexpression and OS (p=0.41), CSS (p=0.92) and BRFS (p=0.31). Cox regression analysis showed Gleason score (p=0.003) and metastatic status (p<1×10-5) to be the only significant predictors of prostate CSS.ConclusionsNo significant association was found betweenERGstatus and any of our outcome measures. Despite a limited sample size, our results suggest thatERGdoes not appear to be a useful biomarker in predicting response to ADT in patients with high risk prostate cancer.

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Recommended Definitions of Aggressive Prostate Cancer for Etiologic Epidemiologic Research

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa154 ◽

2020 ◽

Author(s):

Lauren M Hurwitz ◽

Ilir Agalliu ◽

Demetrius Albanes ◽

Kathryn Hughes Barry ◽

Sonja I Berndt ◽

...

Keyword(s):

Prostate Cancer ◽

Confidence Interval ◽

Gleason Score ◽

Specific Antigen ◽

Sensitivity Analyses ◽

Consensus Definition ◽

Epidemiologic Research ◽

Aggressive Prostate Cancer ◽

Definition Of ◽

Fatal Prostate Cancer

Abstract Background In the era of widespread prostate-specific antigen testing, it is important to focus etiologic research on the outcome of aggressive prostate cancer, but studies have defined this outcome differently. We aimed to develop an evidence-based consensus definition of aggressive prostate cancer using clinical features at diagnosis for etiologic epidemiologic research. Methods Among prostate cancer cases diagnosed in 2007 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results-18 database with follow-up through 2017, we compared the performance of categorizations of aggressive prostate cancer in discriminating fatal prostate cancer within 10 years of diagnosis, placing the most emphasis on sensitivity and positive predictive value (PPV). Results In our case population (n = 55 900), 3073 men died of prostate cancer within 10 years. Among 12 definitions that included TNM staging and Gleason score, sensitivities ranged from 0.64 to 0.89 and PPVs ranged from 0.09 to 0.23. We propose defining aggressive prostate cancer as diagnosis of category T4 or N1 or M1 or Gleason score of 8 or greater prostate cancer, because this definition had one of the higher PPVs (0.23, 95% confidence interval = 0.22 to 0.24) and reasonable sensitivity (0.66, 95% confidence interval = 0.64 to 0.67) for prostate cancer death within 10 years. Results were similar across sensitivity analyses. Conclusions We recommend that etiologic epidemiologic studies of prostate cancer report results for this definition of aggressive prostate cancer. We also recommend that studies separately report results for advanced category (T4 or N1 or M1), high-grade (Gleason score ≥8), and fatal prostate cancer. Use of this comprehensive set of endpoints will facilitate comparison of results from different studies and help elucidate prostate cancer etiology.

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