Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer

Intraductal carcinoma of the prostate(IDC-P)is an aggressive pathological pattern of prostate cancer(PCa).We investigated the association of IDC-P in prostate biopsy(PBx)with several pathological features after radical prostatectomy(RP)and its prognostic value in high-risk PCa.A total of 418 patients with high-risk PCa after RP were included in this study.IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification.Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features.Kaplan-Meier curves and Cox regression were applied to explore the prognostic value of IDC-P.IDC-P was identified in PBx in 36/418(8.6%)patients.Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP,including Gleason score 8-10(P<0.001),seminal vesicular invasion(P<0.001),and pathological T(pT)3a(P=0.043).Patients with IDC-P in PBx manifested poorer biochemical-free survival(BFS)than those without IDC-P(37.47 months vs not reached,P<0.001).The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools.We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa.In addition,IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.

The presence of intraductal carcinoma of the prostate is closely associated with poor prognosis:a systematic review and meta-analysis

We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate(IDC-P)for prognosis and the associations between IDC-P and clinicopathological parameters.Studies were identified in PubMed,Cochrane Library,EMBASE,Web of Science,and SCOPUS up to December 1,2019.Hazard ratios(HRs)for survival data and odds ratios for clinicopathological data with 95%confidence intervals(CIs)were extracted.Heterogeneity was evaluated by the I2 value,and quality was assessed by the Newcastle-Ottawa Scale criteria.A total of 4179 patients from 13 studies were included.The results showed that IDC-P presence was significantly associated with poor progression-free survival(PFS;HR=2.31;95%Cl:1.96-2.73),cancer-specific survival(HR=1.89;95%Cl:1.28-2.77),and overall survival(HR=2.14;95%Cl:1.53-3.01).In the subgroup analysis,IDC-P presence was significantly associated with poor PFS in prostate cancer treated by radical prostatectomy(HR=2.48;95%Cl:2.05-3.00)and treated by radiotherapy(HR=2.83;95%Cl:1.65-4.85).Regarding clinicopathological characteristics,patients with IDC-P presence had significantly higher tumor clinical stages,Gleason scores,probabilities of lymph node invasion,positive surgical margins,and positive extraprostatic extension.Our meta-analysis indicates that the presence of IDC-P is closely associated with poor prognosis and adverse clinicopathological characteristics.Our data support the value and clinical utility of the routine detection of IDC-P by pathological examination.These conclusions need further validation,and prospective studies are needed to find better treatment modalities other than traditional first-line therapy for patients with IDC-P.

Immunohistochemical analysis of PD-L1 and tumor-infiltrating immune cells expression in the tumor microenvironment of primary signet ring cell carcinoma of the prostate

Primary signet ring cell carcinoma(SRCC)of the prostate is a rare neoplasm.However,its potential tumorigenic mechanism,clinicopathological features,and prognostic outcome have not been systematically described.To determine the pathogenic mechanism,we detected distributions of programmed cell death-ligand 1(PD-L1),programmed death 1(PD-1),and cellular components in the tumor microenvironment,including tumor-infiltrating lymphocytes(CD4 and CD8),tumor-associated macrophages(TAMs;CD163 and CD68),and tumor-associated fibroblasts(vimentin and alpha-smooth muscle actin[α-SMA]),in tumor tissues from four patients with primary prostatic SRCC compared with corresponding adjacent tissues and tumor tissues from 30 patients with prostate adenocarcinoma(PCa)by immunohistochemical staining.We found higher expression of PD-L1,CD163,and CD68 in primary SRCC specimens than that in both corresponding adjacent nontumor specimens and PCa specimens with different Gleason scores,indicating that TAMs may participate in the malignant biological behavior of primary SRCC of the prostate.For further analysis,we searched electronic journal databases and Surveillance,Epidemiology,and End Results(SEER)to identify 200 eligible patients including our four cases.According to Kaplan–Meier survival curve analysis,patients<68 years old,with radical prostatectomy(RP),Gleason score of 7–8,and lower clinical stage had longer overall survival(OS).Moreover,Cox multivariate analysis indicated that race(hazard ratio[HR]=1.422),surgical approach(HR=1.654),and Gleason score(HR=2.162)were independent prognostic factors for OS.Therefore,primary SRCC of the prostate represents a distinct and aggressive subtype of prostate cancer associated with a higher distribution of PD-L1 and TAMs,which warrants further clinical investigation.