Pathologists keeping eye out for a 'bad actor' known as intraductal carcinoma--not recommended for Active Surveillance
Rockin' in the free (PSA) world with PCa
(Note: Dr. Ming Zhou’s column provides a short course on prostate pathology for patients with prostate cancer. His “The Pathology Report” column demystifyies the prostate biopsy pathology reports to help patients like you and me understand how the pathology results may influence prostate cancer management decisions. He has covered “atypical prostate glands” and “cribriform cancer glands.” Now, he explains “intraductal carcinoma.” HW)
The Pathology Report: Intraductal Carcinoma of the Prostate
Question: What is “intraductal carcinoma of the prostate”?
Dr. Ming Zhou answers: In pathology reports, you may see a diagnosis of “intraductal carcinoma of the prostate,” IDC. It describes the cancer cell proliferation within benign glands, i.e., benign prostate glands are colonized by bad cancer cells.
IDC glands are usually much larger than and often look very different from the benign glands (see attached image. IDC glands are in the center and benign glands are on the right side of the image).
The incidence of IDC is about 2.8% of all prostate biopsy specimens, 11–14% of biopsies that contain cancer. In radical prostatectomy specimens, the reported incidence is higher, ranging from 15.4 to 31.1%.
What does “intraductal carcinoma” mean for patients’ outcomes and treatment?
Numerous studies have shown that IDC is a bad actor in prostate cancer. It has a profound negative impact on the clinical outcomes of prostate cancer when diagnosed in both prostate biopsies and radical prostatectomies, and strongly correlates with biochemical [PSA] recurrence and patient survival.
Therefore, patients with IDC diagnosed in biopsies are not recommended to choose active surveillance. Both National Comprehensive Cancer Center Network (NCCN) and the Philadelphia Prostate Cancer Consensus Conference recommend germline testing for DNA damage response genes such as BRCA2 when IDC is found.
That is why IDC is included in the prostate biopsy reports. You would think IDC would be incorporated in the prostate cancer risk tools, such as NCCN risk stratification, for the purpose of the prediction of prognosis and patient management.
But it is not!
Pathologists are only required to make a note of the presence of IDC and its negative impact on the prognosis. Hopefully, doctors and patients are well informed to know the significance of IDC in the prostate tissue. But it remains possible that IDC is inadvertently ignored as an important pathological feature for prognosis and patient management and cancer registration.
More studies have looked at ways to incorporate IDC into the prostate cancer risk tools. For example, a recent study found adding IDC to prostate biopsy would strengthen the pretreatment risk stratification using several risk tools including NCCN. I recently wrote a review to urge pathologists to incorporate IDC in the Gleason grading.
Reference:
Jerasit Surintrspanont and Ming Zhou. Intraductal Carcinoma of the Prostate: To Grade or Not to Grade. Cancers (Basel). 2023 Nov; 15(22): 5319.
Downes MR et al. Addition of Cribriform and Intraductal Carcinoma Presence to Prostate Biopsy Reporting Strengthens Pretreatment Risk Stratification Using CAPRA and NCCN Tools. Clin Genitourin Cancer. 2024 Feb;22(1):47-55. doi: 10.1016/j.clgc.2023.07.013.
Dr. Zhou is the Chair and Pathologist-in-Chief of the Tufts Medical Center, and Professor and Chair of the Department of Anatomic and Clinical Pathology, Tufts University School of Medicine in Boston. He has published over 200 peer-reviewed articles and numerous book chapters and edited five textbooks of urological and prostate pathology. He is currently a member of the United States and Canadian Academy of Pathology Board of Directors, and the immediate past President of the Genitourinary Pathology Society (GUPS), an international organization for urological pathologists.
Please send questions to mailto:pros8canswers@gmail.com or cut and paste: pros8canswers@gmail.com
Keep the questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, how it’s going for for you. Share a whimsical signature if you’re so inclined.
Rockin’ the free world with prostate cancer (apologies to Neil Young)
By Howard Wolinsky
Plenty of songs have been written about broken hearts. I’m not sure any will ever be written about prostate glands.
But there have been enough rockers diagnosed with prostate cancer lately that we could launch a Prostate Cancer Rockers Hall of Fame, and a band or two.
The latest to join the PCa Rockers Club is Triumph’s Rik Emmett, 70, a Canadian Music Industry Hall of Famer. He wrote “When A Heart Breaks.” Maybe he can tackle a prostate cancer next? “When A Prostate Breaks” or “Ode to a reluctant warrior”?
Emmett, a guitarist and vocalist, said of his cancer: "Everything's not bad. I can't say I'm a hundred percent, but I'm 70 years old, and, by and large, I'm pretty good. The prostate cancer, I think, is under control and being treated. And I'm taking some medications that follow along after having the radiation. I'm getting some arthritis things that are starting to happen. And it was getting into my hands, which was worrying me a little bit. I've been playing, pushing myself to play a little bit more guitar every day. And I think it actually helps."
He said his father had a slow-growing prostate cancer with which he lived for 20 years. He noted that all men—if they live long enough—will have prostate cancer.
I always wonder in these celeb cases whether these men have been candidates for and offered active surveillance. Active Surveillance still is in search of a musician poster childs.
The rocker said: “It's just if you live long enough, you're probably gonna get it. So it doesn't freak me out. It would freak me out if somebody sat me down and said, 'Yeah, it's moved. We're finding it in other places now.' 'Cause I've been there with my brothers and my mom. And you go 'Well, that's not good. How much time have I got?'"
Other living members of the Prostate Cancer Rock Choir include Elton John, the
Grateful Dead’s Phil Lesh, Rod Stewart, Duran Duran’s Andy Taylor, Judas Priest’s Rob Halford, and Rage Against the Machine’s Tim Commerford.
(Name the ProsRockers Contest. Which ones are missing from the collage? Who’s in the collage that isn’t mentioned by name? And who did I miss altogether? Write your answers to: pros8canswers@gmail.com (cut and paste). Maybe I’ll have some prizes.)
Frank Zappa, who died in 1993 three years after being diagnosed with prostate cancer, is in the collage.
I took some photos of Zappa’s unexpected bust in Vilnius (Vilna), Lithuania in 2012. I have no idea why he landed in Vilnius.
ASPI reskeds BPH webinar to March 23, bowing to PCRI mid-year conference
Active Surveillance Patients International is rescheduling its webinar “ABCs of BPH” to noon-1:30 p.m. Eastern on March 23 because of an overlap with the mid-year conference of Prostate Cancer Research Institute.
So to get this straight. Register for the ASPI program on March 23—not March 30—here: https://zoom.us/meeting/register/tJYoduChrzIrH9dHBNZXqD_pOUCG85yv_KQF#/registration If you’ve already registered, Zoom will get you straight.
Sign up for the PCRI virtual meeting on March 30 here: https://pcri.org/2024-midyear-update
Any one else told 'bout IDC by provider? Roger, Roger Dangerfield, oh lord, we need you; "Bupkes!"
Steve,
Never had anything on IDC before.
Thanks to dr. Ming Zhou. He told me he wanted to help the community of PCa patients. I offered him some avenues. His column was one. I hope it helps.
Me, the Mother Teresa of Prostate Cancer? That's a new one? I like the imagery there.
I see there is a patron saint for cancer and liver cancer. But thus far nine for prostate cancer.
The patron saint of all cancer patients is Saint Peregrine Laziosi (1260 – 1345). Late in life, Saint Peregrine developed what was most likely skin cancer on his foot. The only “cure” was amputation. Before the operation, Peregrine saw a vision of Jesus who touched and healed his foot.
This website--https://discover.hubpages.com/religion-philosophy/Patron-Saints-of-Cancer-Patients-- looks for patron saints for cancers.
It covers saints for breast, liver, brain, testicular (close), bladder (close), cervical, uterine, lung, leukemia and more.
But the saint of prostate cancer, especially low-risk PCa?.
Bupkes, as Jesus might have said, if he spoke Yiddish rather than Aramaic.
The site says: "Prostate Cancer -- So far, I have not discovered a patron saint for prostate cancer patients. I will continue searching. However, I feel Saint Joseph, foster father of Jesus, and Saint Isidore the Farmer (c 1070 -1130) are ideal candidates for the time-being."
It figures. We don't the most attention for research and funding--even though we have the most commonly diagnosed cancer in men and the second most deadly.
Prostate cancer is common but as Rodney Dangerfield, a king, if not a saint. of comedy, put it: "We don't get no respect."