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

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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Malakoplakia of the prostate masquerading as locally advanced prostate cancer on mpMRI

Canadian Urological Association Journal ◽

10.5489/cuaj.3235 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 910 ◽

Cited By ~ 3

Author(s):

Robert Thomas Dale ◽

Michael Metcalfe ◽

Silvia Chang ◽

Edward Jones ◽

Peter Black

Keyword(s):

Locally Advanced ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Locally Advanced Prostate Cancer ◽

E Coli ◽

Intravenous Antibiotics ◽

Left Apex ◽

Left Base ◽

The Right ◽

Extraprostatic Extension

A 66-year-old man was referred for urological evaluation for an abnormal digital rectal exam (cT2a, subtle nodule at left base, 121 cc prostate) and an elevated prostate specific antigen (PSA) of 8.0 ng/ml. Subsequent 12-core transrectal ultrasound (TRUS)- guided biopsy revealed Gleason 3+4 adenocarcinoma in seven of 12 cores, including all six cores on the right side and one core at the left apex. No extraprostatic extension was identified. Postbiopsy, the patient developed urinary retention requiring a catheter, as well as an Escherichia coli (E. coli) urinary tract infection (UTI) requiring hospitalization and intravenous antibiotics.

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Sphenoid Sinus Metastasis as the Presenting Manifestation of a Prostatic Adenocarcinoma: Case Report and Overview of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2012/819809 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

I. Puche-Sanz ◽

F. Vázquez-Alonso ◽

J. F. Flores-Martín ◽

H. Almonte-Fernández ◽

J. M. Cózar-Olmo

Keyword(s):

Sphenoid Sinus ◽

Histopathological Examination ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Axial Skeleton ◽

Subsequent Treatment ◽

Prostatic Adenocarcinoma ◽

Positive Staining ◽

Magnetic Resonance Imaging Mri ◽

The Right

Although a metastatic presentation of an occult prostatic adenocarcinoma is not uncommon, the majority of these patients present with bone metastasis affecting the axial skeleton. Cranial metastases to the paranasal sinuses are extremely rare. A 56-year-old man presented with loss of vision and numbness of the right side of the face. Computed tomography (CT) scan and cranial magnetic resonance imaging (MRI) revealed a mass invading the sphenoid sinus. The patient underwent surgery to remove the lesion, and the histopathological examination suggested metastasis of an adenocarcinoma, with positive staining to prostatic specific antigen (PSA). However, serum PSA was 4 ng/mL, and the patient did not report any lower urinary tract symptoms or bone pain. Transrectal ultrasound-guided biopsy revealed prostatic adenocarcinomas with a Gleason score of 8 [4 + 4]. The subsequent treatment consisted of radiotherapy and androgen deprivation, followed by first- and second-line chemotherapy (docetaxel and cabazitaxel) when the disease progressed. The patient achieved a good response with the last cycle of cabazitaxel and after a 5-year followup is currently alive. Cranial metastases of prostate adenocarcinoma are rare, and there is currently no standard treatment for these patients. Whenever possible, surgery combined with radiotherapy and hormonotherapy is the recommended option.

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Synchronous Penile Metastasis from a High-Grade Adenocarcinoma of the Prostate

Case Reports in Urology ◽

10.1155/2012/193787 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

S. Dijkstra ◽

A. G. van der Heijden ◽

H. E. Schaafsma ◽

P. F. A. Mulders

Keyword(s):

Specific Antigen ◽

Transrectal Ultrasound ◽

Digital Rectal Examination ◽

Glans Penis ◽

High Grade ◽

Penile Metastasis ◽

Prostate Biopsies ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Adenocarcinoma Of The Prostate

Metastasis to the glans penis is a rare phenomenon and usually occurs in a late stage of disease. A 68-year-old man was referred to our clinic because of two indurated lesions of the glans penis and minor lower urinary tract symptoms. Digital rectal examination revealed a hard nodular prostate, and serum prostate-specific antigen (sPSA) level was 13.3 ng/mL. Biopsies of the penile lesions and transrectal ultrasound-guided prostate biopsies were taken. Immunohistochemical staining of formalin-fixed paraffin-embedded tissue exposed a synchronous penile metastasis from a high-grade adenocarcinoma of the prostate. Except a pathologically enlarged lymph node detected with MRI there was no suspicion on other metastases. Currently this patient is being treated with a Gonadoreline (GnRH) antagonist. Nevertheless, the prognosis will be poor.

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Prostate Cystadenocarcinoma: A Rare Cystic Epithelial Lesion in an Unusual Clinical Setting

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz113.059 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S61-S61

Author(s):

Sunjida Ahmed ◽

Fang-Ming Deng ◽

Jonathan Melamed

Keyword(s):

Prostate Biopsy ◽

Locally Advanced ◽

Specific Antigen ◽

Elevated Serum ◽

Urinary Symptoms ◽

Resected Specimen ◽

Current Case ◽

Gleason Pattern ◽

Cystic Tumors ◽

The Right

Abstract Introduction Cystic tumors of prostate are rare and their clinicopathologic significance remains to be defined. The tumors present with either obstructive urinary symptoms or elevated serum prostate-specific antigen (PSA). Here we report a multilocular cystadenocarcinoma in a patient without significant urologic symptoms. Case Report A 71-year-old male with prior abnormal prostate biopsy, 6 years previously (unknown pathology), was referred for prekidney transplant workup. His symptom of oliguria and proteinuria was associated with end-stage renal disease without any obstructive urinary symptoms. Serum PSA detected 5.5 ng/mL. Magnetic resonance imaging (MRI) of the pelvis demonstrated a multilocular cystic lesion measuring 6.2 × 4.6 cm, arising from the right peripheral zone of prostate. The patient underwent MRI-guided prostate needle biopsy. Histology of prostate biopsy revealed glands and cystic structures lined by cuboidal to columnar epithelial cells with basally located hyperchromatic nuclei, pseudostratification, and focal papillary architecture. The cyst wall was immunoreactive for Cam 5.2, NKX 3.1, and AMACR, while negative for PAX8 and 34BE12 and p63, suggesting a diagnosis of primary prostate cystadenocarcinoma. The patient underwent robotic prostatectomy. The resected specimen showed a soft periprostatic mass, 6.8 × 5.0 cm at the right posterolateral aspect. Cut sections showed multiple multilocular cysts, with papillary projections, involving the right posterior-lateral surfaces with extensive extraprostatic extension. Histology showed multilocular cysts with papillary lining. Immunohistochemical studies showed strong reactivity of the cyst lining for NKX3.1, AMACR, weak CDX-2, and absent 34be12, p63, and ERG reactivity. The microscopic and immunohistochemical evidence supported a diagnosis of prostate cystadenocarcinoma, stage pT3a with free resection margin. Conclusion Cystadenocarcinoma is a variant of prostate carcinoma associated with obstructive urinary symptoms and potential for locally advanced growth. This case and other published reports of prostate cystadenocarcinoma show histologic features similar to the ductal variant of prostate adenocarcinoma, and therefore we suggest to grade it as Gleason pattern 4. The current case of prostate cystadenocarcinoma was an incidental diagnosis in an asymptomatic patient with mildly elevated PSA (T1c).

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Trigeminal Cave Brain Metastasis from Prostate Adenocarcinoma: Case Report and Review of the Literature

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1676525 ◽

2018 ◽

Vol 37 (04) ◽

pp. 330-333

Author(s):

João Zanatta ◽

Laisa Zanella ◽

Guilherme Kurtz ◽

Bárbara Gabardo ◽

Alex Roman ◽

...

Keyword(s):

Prostate Cancer ◽

Brain Metastases ◽

Prostate Specific Antigen ◽

Cranial Nerve ◽

Specific Antigen ◽

Prostate Adenocarcinoma ◽

Brain Parenchyma ◽

Surgical Removal ◽

Magnetic Resonance Imaging Mri ◽

The Right

The present study presents the case of a 66-year-old patient diagnosed with prostate adenocarcinoma 4 years earlier and treated with prostatectomy, radiotherapy, chemotherapy and hormone therapy but still displaying high prostate-specific antigen (PSA) levels. The patient complaints were double vision and headaches. Upon physical examination, he displayed 6th cranial nerve paresis and 5th cranial nerve paresthesia. A magnetic resonance imaging (MRI) exam was performed, which revealed a mass on the right trigeminal cave. The patient underwent surgical removal of the tumor, and the pathological analysis of the specimen established metastatic prostate cancer as the diagnosis.Brain metastases from prostate cancer are extremely rare and mark advanced disease, with immune system failure and blood-brain barrier breach. Prostate-specific antigen levels do not correlate with the possibility of metastatic disease. Prostate adenocarcinoma is the histologic type most commonly associated with brain metastases, with the meninges being more frequently affected, followed by the brain parenchyma. The neurological symptoms more often displayed are non-focal, such as headaches and mental confusion. Surgery associated with radiotherapy is the most validated treatment.

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Ductal Adenocarcinoma of the Prostate: A Case Report

Case Reports in Oncology ◽

10.1159/000453448 ◽

2016 ◽

Vol 9 (3) ◽

pp. 802-805 ◽

Cited By ~ 1

Author(s):

Yutaro Hayashi ◽

Takashi Kawahara ◽

Hiromichi Iwashita ◽

Kota Shimokihara ◽

Sohgo Tsutsumi ◽

...

Keyword(s):

Case Report ◽

Radical Prostatectomy ◽

Needle Biopsy ◽

Rare Case ◽

Specific Antigen ◽

Ductal Adenocarcinoma ◽

Antigen Level ◽

Prostate Needle Biopsy ◽

Unusual Variant ◽

Adenocarcinoma Of The Prostate

Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate. A 73-year-old male was referred to our hospital for the further examination of an elevated prostate-specific antigen level of 23.4 ng/mL. Radical prostatectomy (RP) was performed based on the diagnosis obtained by a prostate needle biopsy. The RP specimen revealed ductal adenocarcinoma of the prostate with positive capsular penetration. We herein report a rare case of ductal adenocarcinoma of the prostate.

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Primary Urothelial Carcinoma of the Prostate with Glandular Differentiation: A Case Report

Urologia Internationalis ◽

10.1159/000363335 ◽

2014 ◽

Vol 98 (3) ◽

pp. 370-372 ◽

Cited By ~ 2

Author(s):

Peng Lai ◽

Ming Luo ◽

Guanghui Hu ◽

Huan Liu ◽

Liang Xu ◽

...

Keyword(s):

Radical Prostatectomy ◽

Urothelial Carcinoma ◽

Histopathological Examination ◽

Specific Antigen ◽

Repeated Testing ◽

Local Tumor Recurrence ◽

Before And After ◽

History Of ◽

Adenocarcinoma Of The Prostate ◽

Magnetic Resonance Imaging Mri

A 53-year-old man presented to our department with acute urinary retention and an approximate 8-year history of frequent urination, dysuria, poor urinary stream and nocturia. His prostate-specific antigen (PSA) values were normal (<4 ng/ml) upon repeated testing. The patient was diagnosed with benign prostatic hyperplasia, although there was no significant improvement in his symptoms after treatment with oral finasteride and doxazosin. He then underwent transurethral resection of the prostate in February 2013, and histopathological examination showed adenocarcinoma of the prostate. His treatment regimen included daily oral bicalutamide and subcutaneous injection of Zoladex once per month. Three months later, radical prostatectomy was performed, and a prostate histopathological examination indicated primary urothelial carcinoma with glandular differentiation. His PSA values were normal (<4 ng/ml) before and after the radical prostatectomy. After the second operation, the patient received chemotherapy with gemcitabine and cisplatin. Two months later, magnetic resonance imaging (MRI) indicated local tumor recurrence. The patient was treated with chemotherapy combined with radiotherapy for 2 months, and subsequent MRI results showed that the recurrent tumor volume was significantly reduced. As a result, radiotherapy was stopped. The patient remains alive, and his general condition has clearly improved.

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MRI Finding of Prostatic Ductal Adenocarcinoma

Case Reports in Oncology ◽

10.1159/000518531 ◽

2021 ◽

pp. 1333-1337

Author(s):

Kazuhiro Kitajima ◽

Shingo Yamamoto ◽

Takashi Yamasaki ◽

Takako Kihara ◽

Yusuke Kawanaka ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Specific Antigen ◽

Ductal Adenocarcinoma ◽

High Signal ◽

Weighted Image ◽

Multilocular Cyst ◽

Cystic Formation ◽

Total Prostatectomy ◽

The Right

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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Salvage Radiotherapy for Biochemically Recurrent Prostate Cancer After Prostatectomy

Journal of Clinical Oncology ◽

10.1200/jco.2016.69.2509 ◽

2016 ◽

Vol 34 (32) ◽

pp. 3829-3833 ◽

Cited By ~ 4

Author(s):

Zachary S. Zumsteg ◽

Timothy J. Daskivich ◽

Howard M. Sandler

Keyword(s):

Relevant Literature ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Digital Rectal Examination ◽

Positive Margin ◽

Pelvic Lymphadenectomy ◽

Salvage Radiotherapy ◽

Mild Stress ◽

Health Maintenance ◽

The Right

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 67-year-old man had presented to his primary physician for routine health maintenance. A digital rectal examination was performed and revealed a suspicious nodule in the right lobe of the prostate without any extraprostatic extension. A serum prostate-specific antigen (PSA) test was 12.4 ng/mL. He had no previous PSA tests. Transrectal ultrasound-guided prostate biopsy showed Gleason 3 + 4 prostate adenocarcinoma in seven of 12 cores. Bone scan and computed tomography scan of the pelvis showed no evidence of metastatic disease, and the patient underwent a robotic-assisted radical prostatectomy with bilateral pelvic lymphadenectomy. Pathology revealed Gleason 3 + 4 adenocarcinoma bilaterally, with extracapsular extension, no seminal vesicle invasion, a 2-mm positive margin at the right mid gland, and 0 of 15 lymph nodes containing adenocarcinoma. Two months after surgery, he had mild stress urinary incontinence and PSA of < 0.1 ng/mL. Adjuvant radiotherapy was discussed, but he elected to have careful follow-up. His PSA was monitored every 6 months and gradually increased from < 0.1 ng/mL to 0.4 ng/mL over the next 3 years. He was asymptomatic. He was referred to discuss the role of salvage radiotherapy.

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Optimization of Risk Stratification in Localized Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2017.76.2971 ◽

2018 ◽

Vol 36 (6) ◽

pp. 528-532 ◽

Cited By ~ 1

Author(s):

Alicia Katherine Morgans

Keyword(s):

Prostate Cancer ◽

Relevant Literature ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Digital Rectal Examination ◽

Localized Prostate Cancer ◽

Gleason Grade ◽

Management Options ◽

Grade Group ◽

The Right

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 67-year-old retired engineering professor was found to have a prostate-specific antigen (PSA) level of 11 ng/mL on a screening test at his annual physical examination. A digital rectal examination revealed a nodule on the right side. He underwent a transrectal ultrasound-guided prostate biopsy that was notable for prostate adenocarcinoma, Gleason 3 + 4 = 7 (Gleason grade group 2; 30% Gleason 4 component) involving two cores (60% and 20% core involvement). A bone scan and pelvic computed tomography scan were negative for evidence of metastatic disease. (Should he undergo prostate magnetic resonance imaging? That seems rather common these days.) He was diagnosed with cT2b intermediate-risk localized prostate cancer (PCa) by National Comprehensive Cancer Network (NCCN) risk group and was seen in the multidisciplinary clinic to discuss management options (Table 1).

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