The New Cancer Infolink posted a summary of an article by Dr. Bonkoff about
Intraductal carcinoma of the prostate (IDC-P). He describes what this is, and how it should be differentiated from high grade PIN. He also points out that IDC-P is closely associated with aggressive, high-Gleason grade PCa, and when it is found, there is a high likelihood of radiation treatment failure.
prostatecancerinfolink.net/2012/09/28/intraductal-carcinoma-of-the-prostate-should-be-clearly-identified-by-pathologists/#comment-27617In particular, the article stated:
Bonkhoff said...
The incidence of IDC-P in prostatectomy specimens depends on tumor volume. In the series of McNeal, IDC-P was observed in 10% of cases with tumor volume less than 2 ccm, 28% in tumors between 2 and 4 ccm, and 47% in tumors larger than 4 ccm 2. In prostatectomy specimens, IDC-P is virtually always associated with invasive cancer, which makes the diagnosis of intraductal spread and its separation from HGPIN much easier than in cases of isolated IDC-P in prostate biopsy. Given its prognostic significance, the amount or percent of IDC-P should be reported. A new postoperative nomogram incorporates IDC-P as a variable, and may enhance prediction 32.
Reporting IDC-P on prostate biopsies both as a rare isolated finding and as a more common finding in combination with prostatic adenocarcinoma is of paramount importance, because its diagnosis has, in apparent contrast to HGPIN, profound prognostic implications, and may influence therapeutic decisions. IDC-P on prostate biopsies is frequently associated with high-grade cancer and poor prognostic parameters at radical prostatectomy as well as advanced disease following other therapies 2–12. In a recent study enrolling 250 patients with intermediate and high risk PCa, the presence of IDC-P in prostate biopsies was identified as an independent prognosticator of early biochemical relapse (<36 months) and metastatic failure after radiotherapy 30. This indicates that IDC-P is a significant risk factor for radiation therapy failure. In the presence of IDC-P on prostate biopsies, radical prostatectomy combined with extended lymphadenectomy may be more effective in improving survival than radiotherapy.
I suspect that this will become an important prognostic tool for those found to have high Gleason scores.
Nellie