Carcinome intracanalaire de la prostate

Histopathology. 2025 Jan 30. doi: 10.1111/his.15414. Online ahead of print.ABSTRACTAIMS: Intraductal carcinoma (IDC) is an independent pathological parameter for adverse prostate cancer (PCa) outcome. Although most IDC are believed to originate from retrograde spread of established PCa, rare IDC cases may represent precursor lesions. The actual transition areas between intraductal and invasive cancer, however, have not yet been identified. Our objective was to identify intraductal-invasive PCa transitions using 2- and 3-dimensional microscopy.METHODS AND RESULTS: Seventy-five samples from 46 radical prostatectomies with PCa were immunohistochemically stained for basal cell keratins. In 35 samples, atypical glands that were indistinguishable from invasive adenocarcinoma (IAC) had focal 34BE12-positive basal cells. These IAC-like glands were present adjacent to IDC and prostatic intra-epithelial neoplasia (PIN) in 21 of 45 (46.7%) and 16 of 58 (27.6%) cases, respectively. Whole-mount confocal imaging of immunofluorescent Ker5/18 double-stained and cleared 1-mm-thick intact tissues revealed spatial continuity between IDC, IAC-like glands and IAC with a gradual loss of basal cells. In 24 of 35 (68.6%) samples more than one IAC-like focus (median 3.0) was present.CONCLUSIONS: We identified areas of spatial transition between PIN, IDC and IAC, characterised by remnant basal cells in IAC-like glands. Based on the coexistence of IDC and PIN, the gradual loss of basal cells in IAC-like glands and IAC-like glands' multifocality, we propose a novel hypothesis on intraductal carcinogenesis, which we term 'repetitive invasion, precursor progression' (RIPP).PMID:39888049 | DOI:10.1111/his.15414

BMC Urol. 2025 Jan 20;25(1):10. doi: 10.1186/s12894-025-01690-1.ABSTRACTBACKGROUND: Intraductal carcinoma of the prostate cancer (IDC-P), as a specific pathological type in prostate cancer which usually implies a poor prognosis. IDC-P morphology can be divided into two subtypes: Pattern 1, sieve like or loose cribriform structures; Pattern 2, solid or dense cribriform structures. The purpose of the study is to identify the impact of IDC-P and its subtypes on the prognosis of patients undergoing post-operative radiotherapy (PORT) after radical prostatectomy (RP) due to localized prostate cancer(PCa).METHODS: We performed a retrospective study of patients with localized PCa treated by RP followed by PORT or not. Patients with localized PCa who underwent RP from August 2013 to December 2020 were included in this study.INCLUSION CRITERIA: post-operative PSA dropped to less than 0.1 ng/ml after RP, had at least 1 poor prognostic risk factor (including high Gleason's grouping; positive surgical margins; seminal vesicle invasion; extraprostatic extension; and lympho-vascular invasion), and were eligible for adjuvant radiotherapy.; In this study, patients who underwent salvage radiotherapy after RP due to biochemical recurrence (two consecutive PSA > 0.2 ng/ml) were also included, but not patients with persistent postoperative PSA > 0.1 ng/ml.EXCLUSION CRITERIA: patients using other types of therapy prior to biochemical recurrence. Screening cases with pathological results of intraductal carcinoma, subtyping was completed by a pathologist, grouped by intraductal carcinoma (+/-; pattern 1/ 2) and treatment regimen (RP + PORT / RP only), Kaplan-Meier curves were plotted based on the time to biochemical recurrence-free and overall survival of the patients, and Cox regression analyses were performed. Finally, based on the results of Cox regression analysis, we initially predicted the probability of biochemical recurrence and death of the patients by plotting the nomogram.RESULTS: A total of 139 patients were included in this study with a median follow-up of 61.5 months. K-M curves showed that patients with "IDC-P (+) RP only" had the worst prognosis; patients with IDC-P could have a survival benefit after receiving PORT; whereas patients with non-intraductal carcinoma had a better prognosis than the above patients with or without PORT. In addition, patients with IDC-P(+) pattern 2 were more likely to experience biochemical recurrence and death. Multivariate Cox regression analysis showed that pattern 2 was a risk factor for biochemical recurrence and death. Other BCR-related risk factors in the research: Gleason grading group 5 (HR = 3.343, 95% CI: 1.616-6.916, P = 0.001), PM (HR = 2.124, 95% CI: 1.044-4.320,P = 0.038) and PORT (HR = 0.266, 95%CI: 0.109-0.647, P = 0.004). Other OS-related risk factors in the research: Grading group 5 (HR = 3.642, 95%CI:1.475-8.991, P = 0.005), SVI (HR = 2.522, 95% CI: 1.118-5.691, P = 0.026) and PORT (HR = 0.319, 95%CI: 0.107-0.949, P = 0.040).CONCLUSION: Patients suffering from localized prostate cancer with IDC-P(+), especially IDC-P pattern 2, are more susceptible to biochemical recurrence and death after radical prostatectomy. While postoperative radiotherapy can alleviate the negative prognostic impact from IDC-P. It is implied that IDC-P can also be an indicator to be considered in PORT decision making to some extent.PMID:39833820 | DOI:10.1186/s12894-025-01690-1

Am J Surg Pathol. 2025 Feb 25. doi: 10.1097/PAS.0000000000002376. Online ahead of print.ABSTRACTAtypical intraductal proliferation (AIP) of the prostate is characterized by morphologic features exceeding that of high-grade prostatic intraepithelial neoplasia but not meeting strict diagnostic criteria for intraductal carcinoma. We examined the clinical significance of AIP in biopsy specimens. Patients with AIP diagnosed on biopsy were identified from surgical pathology archives. Initial biopsies, any repeat biopsies, and any radical prostatectomy (RP) slides were rereviewed. We also identified a control group of 50 consecutive patients with available prostate biopsies showing invasive prostatic adenocarcinoma but no AIP and having paired RP for comparison. Medical records were searched for nonsurgical treatment and clinical outcome status. Patients with initial biopsies showing invasive adenocarcinoma with either grade group (GG) ≥3 and/or unfavorable histology (as recently defined) were excluded from both the study and control groups. Correlation with subsequent adverse pathology at rebiopsy or RP, as defined by separate criteria: unfavorable histology, large cribriform/intraductal carcinoma, GG ≥3, pN1, and/or pM1, was assessed for both groups. Phosphate and tensin (PTEN) homolog and ETS-related gene (ERG) immunohistochemistry were performed on biopsies with available paired RP, using standard protocols. One hundred forty-two patients with AIP met inclusion criteria. At initial biopsy, 16 patients (11.3%) had AIP without concomitant invasive carcinoma, whereas 126 (88.7%) also had invasive adenocarcinoma. Of the 126 invasive tumors with AIP meeting study criteria, 19 (15.1%) were GG 1 and 107 (84.9%) GG 2. One hundred thirty-nine of 142 patients with AIP (97.9%) had available clinical follow-up (mean: 36.9 mo). Fifty-two (36.3%) patients with AIP underwent RP, 36 (25.4%) had brachytherapy, 28 (19.7%) had radiotherapy, 17 (12%) remained on active surveillance, 2 (1.4%) had cryoablation, 2 (1.4%) received androgen deprivation therapy, and 1 (0.7%) had high-intensity focused ultrasound. Forty-seven of 52 patients undergoing prostatectomy (90.3%) had glass slides available for review: 30 (63.8%) were GG2, 13 (27.7%) GG3, 1 (2.1%) GG4, and 3 (6.4%) GG5. Seventeen (36.2%) patients were staged as pT2, 25 (53.2%) pT3a, and 5 (10.6%) pT3b. Forty-two of 47 (89.4%) patients had associated unfavorable histology on prostatectomy, including 41 (87.2%) with large cribriform/intraductal carcinoma, 17 (36.2%) GG≥3, and 5 (10.6%) with metastatic disease. In the 36 AIP lesions examined for PTEN and ERG immunoreactivity, 14 (38.9%) had concomitant PTEN loss and ERG over-expression, 6 (16.7%) showed PTEN loss only, and 6 (16.7%) had ERG overexpression only. AIP morphology was more predictive of risk for unfavorable histology at RP than PTEN/ERG immunophenotype. Seventeen patients not undergoing RP had rebiopsy, of which 5 (29.4%) had at least one adverse feature identified on repeat biopsy. Nineteen of 50 patients (38%) in the non-AIP control group had adverse pathology at RP (by any definition), compared with 89.4% in the AIP study group (P < 0.0001). In conclusion, AIP in prostate needle core biopsy is strongly associated with unsampled adverse pathology, defined by unfavorable histology and other traditional definitions of aggressive disease. For optimal patient risk stratification and active surveillance management, AIP should gain better recognition as a standard reporting element given its association with an increased likelihood of unsampled high-risk disease.PMID:39995242 | DOI:10.1097/PAS.0000000000002376