Intraductal

How are you getting on? I have been told I have 2 samples of 12 showing Intraductal carcinoma of the prostate without concomitant prostate cancer in biopsies. Just now they are hunting for another tumour and had another 24 or more taken on Monday with a CT scan today and Bone Scan tomorrow. Results on Tuesday with the threat of more biopsies if nothing is found.

I think Intraductal alone is rare so I wait with baited breath. It doesn’t sound good but anyone’s experience with this would be great.

Thanks Chris

I had better wait till after Tuesday to see if I have any other involvement or spread.

I believe few cases of pure Intraductal have been found - a study over 50 years in the US found around 400 in 450k PCA cases and the term was used more broadly a few years ago. I believe Intraductal and Ductal are not the same, but the terms were used interchangeably.

Lots of uncertainties. 

I read your story and glad your PSA seems stable and very low - I couldn’t make out the rapid rise.

So far I have only Intraductal which apparently doesn’t cause a PSA rise, mine has been between 2.5 -3.5 apart from when I had two prostate infections. CT Scan yesterday, Bone scan today and results on Tuesday. They may find acinar in the last batch of biopsies. If they don’t then I’m told I’m rare.

I have no major symptoms, no getting up at night unless I drink a lot before bed, reasonable flow rates, no blood.

Only picked up after 7 years monitoring post PSA 35 from prostatitis just before I was due to be signed off when urologist suggested a cystoscope and did an unexpected rectal test and felt something. MRI came back 5 on right 3 on left so TRUS and 2 of 12 showed Intraductal but no prostate cancer.

The definition of Intraductal has changed over recent years so past papers may be of patients mixed with something else. I read it returns after surgery and may not respond to hormones. Happy Days

Waiting to see what Tuesday brings.

Just been googling and found some very interesting if a bit confusing facts so there’s some light at the end of the tunnel albeit a long one

“ Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases.

IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered Pure IDCP is a precursor of prostate cancer.”

It seems only 43% of 39 consultants agreed which cells were IDCP

Then there’s

“Ductal Cancer which is a Variant of prostatic adenocarcinoma, 􏰁

ductal􏰂 refers to phenotype ß Intraductal

Growth pattern of adenocarcinoma

Not a variant of prostate cancer 􏰁---ductal􏰂 refers to location (within ducts)”

WHO uses 3 codes for this. Confused...

I’m hoping for Pure IDCP

Then there’s

“Ductal Cancer which is a Variant of prostatic adenocarcinoma, 􏰁

ductal􏰂 refers to phenotype ß Intraductal

Growth pattern of adenocarcinoma

Not a variant of prostate cancer 􏰁---ductal􏰂 refers to location (within ducts)”

WHO uses 3 codes for this. Confused...

I’m hoping for Pure IDCP

************************************************************************************************************************

Be cautious of your sources. Ductal does not simply refer to the location of the cancer although it does tend to congregate in specific places like alongside the urethra. Ductal cells are a version of adenocarcinoma but they look slightly different under a microscope and they behave in a specific way.

Intraductal carcinoma is often found in the ducts..The problem with ductal is that it is more aggressive than it looks, appearing similar to PIN to an inexperienced pathologist

Edited by member 01 Nov 2019 at 17:18  | Reason: Not specified

Here’s an easier read albeit still confusing for me to know were I fit if more tests don’t show another carcinoma.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505500/

“Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases. IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered pure IDCP is a precursor of prostate cancer. This review highlights issues that require further discussion and clarification. The diagnostic criterion “nuclear size at least 6 times normal” is ambiguous as “size” could refer to either nuclear area or diameter. If area, then this criterion could be re-defined as nuclear diameter at least three times normal as it is difficult to visually compare area of nuclei. It is also unclear whether IDCP could also include tumours with ductal morphology. There is no consensus whether pure IDCP in needle biopsies should be managed with re-biopsy or radical therapy. A pragmatic approach would be to recommend radical therapy only for extensive pure IDCP that is morphologically unequivocal for high-grade prostate cancer. Active surveillance is not appropriate when low grade invasive cancer is associated with IDCP, as such patients usually have unsampled high-grade prostatic adenocarcinoma. It is generally recommended that IDCP component of IDCP-inv should be included in tumour extent but not grade. However, there are good arguments in favour of grading IDCP associated with invasive cancer. All historical as well as contemporary Gleason outcome data are based on morphology and would have included an associated IDCP component in the tumour grade. WHO 2016 recommends that IDCP should not be graded, but it is unclear whether this applies to both pure IDCP and IDCP-inv.”

And makes me wonder why the same classification applies to both types.

Here’s another
https://journals.lww.com/ajsp/Abstract/2016/06000/Differential_Diagnosis_of_Intraductal_Lesions_of.1.aspx

“The category of intraductal lesions of the prostate includes a range of primary prostatic and nonprostatic processes with wide variation in prognosis and recommended follow-up. Studies have shown that pathologists are uncomfortable with the diagnosis of these lesions and that the diagnostic reproducibility is low in this category. Despite the diagnostic difficulty, their accurate and reproducible diagnosis is critical for patient management.

to distinguish it from its common mimickers, including high-grade prostatic intraepithelial neoplasia, invasive cribriform prostatic adenocarcinoma, urothelial carcinoma extending into prostatic ducts, and prostatic ductal adenocarcinoma. IDC-P is independently associated with higher risk disease, and its identification in a needle biopsy, even in the absence of invasive carcinoma, should compel definitive treatment. Conversely, high-grade prostatic intraepithelial neoplasia has a much better prognosis and in limited quantities does not even warrant a repeat biopsy. IDC-P must be distinguished from urothelial carcinoma involving prostatic ducts, as recommended treatment varies markedly.
Ductal adenocarcinoma may confuse the pathologist and clinician by overlapping terminology, and morphology may also mimic IDC-P on occasion.”

So a confusing area for everyone.

Edited by member 02 Nov 2019 at 07:22  | Reason: To add reference link

Thanks Lyn

Fair points, and you may well be correct, however as it’s quite rare, there are not many trials of treatments and past literature seems to allow Intraductal to be have been used when only 80% of cells were Intraductal.

If you can find much else on pure intraductal not confused by inclusion of other types since 2016 I’d be very grateful. Do you not think the authors are experts in the area? 

You don’t say but I wonder are you medically qualified?

I used to work in medicines information assessing new products when most data came from sponsored trials and then in University. I’m well aware of what you say. However in new or changing fields where there is no research or trials just case studies or consensus views to go on that doesn’t work. I’m afraid in retirement I don’t have access to the data bases, only google.

if you google “pure Intraductal prostatic cancer” there are only 3 references that appear, the rest are not that disorder, but mixed cases or Ductal. Maybe you can find more in which case I’d be grateful to see what they say.

Do you believe there is pure Intraductal. Another study I saw found 2 prostates removed out of 21 IDCP patients had no other tumour present. 

In 2015 Johns Hopkins slides!!  30-34 reported on 901 prostate cancers of which 141 had ID with adjacent invasive tumours 14 had  ID with a distant tumour. They refer to various types of ID one being a precursor.

https://handouts.uscap.org/AN2015/Companion%20Meeting%20(CM)/CM15-15/intraductallesions-40minutes%20[Compatibility%20Mode]Epstein.pdf

Anyway let’s wait till I get my results and advice on Tuesday as all this may be academic lol! 

Thanks Lyn for trying and the good wishes.

i think Intraductal is poorly understood because it’s usually associated with other tumours there are very few people with what may be called pure Intraductal, I think the medical view is there’s a tumour in there somewhere and we will biopsy till we find it. It seems Differential diagnosis isn’t easy or highly reproducible between pathologists. Patient numbers are probably too small for trials unless done continent wide. There’s not a lot of money to be had from treating it either.

On Tuesday If there’s a tumour then game over. If there’s no tumour yet then they will probably want to go perineal to look even more. 

I’m 73 have no symptoms, low PSA, have had several brushes with my mortality at 50 and 60 so maybe have a different perspective. I have lots of questions to ask Tuesday from what I have read if there is nothing - hope I get chance to ask them.

best wishes

2 of 22 second set of cores had 5% of acinar so it’s Gleason 6 and probably active monitoring for me depending on CT scan, but bone scan negative and MRI says no lymph nodes affected. I suppose it’s great news or at the least the best news I could expect.

Thanks for listening to the trials and tribulations.

Best wishes

Good news that it isn’t intraductal.

All the best,