Biopsy diagnosis of intraductal carcinoma is prognostic in intermediate and high risk prostate cancer patients treated by radiotherapy

• Published in: European journal of cancer (1990) Vol. 48; no. 9; pp. 1318 - 1325
• Main Authors: Van der Kwast, T, Al Daoud, N, Collette, L, Sykes, J, Thoms, J, Milosevic, M, Bristow, R.G, Van Tienhoven, G, Warde, P, Mirimanoff, R.-O, Bolla, M
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.06.2012; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biopsy - methods; Carcinoma, Intraductal, Noninfiltrating - diagnosis; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - radiotherapy; Carcinoma, Intraductal, Noninfiltrating - surgery; Clinical progression; Cohort Studies; Disease-Free Survival; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Hormone therapy; Humans; Intermediate risk; Intraductal carcinoma; Kaplan-Meier Estimate; Male; Medical sciences; Metastatic disease; Middle Aged; Neoplasm Grading; Pharmacology. Drug treatments; Prognosis; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy; Risk Factors; Treatment Outcome; Tumors; Metastatic disease; Intraductal carcinoma; Prognosis; Hormone therapy; Clinical progression; Radiotherapy; Prostate cancer; Intermediate risk; Human; High risk; Ductal carcinoma; Urinary system disease; Prostate disease; Malignant tumor; Metastasis; Anatomic pathology; Cancerology; Biopsy; Risk factor; Evolution; Advanced stage; Diagnosis; Male genital diseases; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2012.02.003

Abstract Aim We investigated the prognostic significance of intraductal carcinoma of the prostate (IDC-P) in biopsies and transurethral resections prior to external beam radiotherapy with or without androgen deprivation. Methods Cohort 1 consisted of 118 intermediate risk prostate cancer patients treated by radiotherapy, with biochemical relapse as primary end-point (median follow-up 6.5 years). Cohort 2 consisted of 132 high risk patients, enrolled in a phase III randomised trial (EORTC 22863) comparing radiotherapy alone to radiotherapy with long-term androgen deprivation (LTAD) with clinical progression free survival as primary end-point (median follow-up 9.1 years). Presence of IDC-P was identified after central review. Multivariable regression modelling and Kaplan–Meier analysis were performed with IDC-P as dichotomous variable. Results IDC-P was a strong prognosticator for early (<36 months) biochemical relapse (HR 7.3; p = 0.007) in cohort 1 and for clinical disease-free survival in both arms of cohort 2 (radiotherapy arm: HR 3.5; p < 0.0001; radiotherapy plus LTAD arm: HR 2.8, p = 0.018). IDC-P retained significance after stratification for reviewed Gleason score in the radiotherapy arm (HR 2.3; p = 0.03). IDC-P was a strong prognosticator for metastatic failure rate (radiotherapy arm: HR 5.3; p < 0.0001; radiotherapy plus LTAD arm: HR 3.6; p = 0.05). Conclusions IDC-P in diagnostic samples of patients with intermediate or high risk prostate cancer is an independent prognosticator of early biochemical relapse and metastatic failure rate after radiotherapy. We suggest that the presence of IDC-P in prostate biopsies should routinely be reported.