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Background and objective <p>Ductal adenocarcinoma (DAC) is the second most common subtype of prostate cancer and is believed to have more aggressive biology compared to acinar adenocarcinoma (AAC). This study aimed to compare pathological and oncological outcomes between DAC and AAC in patients undergoing robotic-assisted radical prostatectomy (RARP).</p> Methods <p>This was a single-center, retrospective cohort study of consecutive patients who underwent RARP between 2008 and 2023. Patients with DAC or AAC on final pathology were included. A 1:1 propensity score matching was performed based on key clinicopathologic variables. Primary outcomes included adverse pathological features, biochemical persistence, and biochemical recurrence (BCR). Statistical analyses included logistic regression and Cox proportional hazards models.</p> Key findings and limitations <p>Among 844 DAC and 14,357 AAC patients (median follow-up: 4.1&#xa0;years), DAC was associated with higher extracapsular extension (48.2% vs. 35.4%, difference = 12.8%, 95% CI: 9.4–16.3, <i>p</i> &lt; 0.001), biochemical persistence (8.3% vs. 4.4%, OR = 1.97, 95% CI: 1.52–2.56, <i>p</i> &lt; 0.001), and BCR (20.1% vs. 12.5%, HR = 1.70, 95% CI: 1.44–2.01, <i>p</i> &lt; 0.001). In the matched cohort, DAC had higher biochemical persistence (8.4% vs. 5.5%, OR = 1.58, 95% CI: 1.07–2.33, <i>p</i> = 0.03) but no differences in BCR or overall survival. Limitations include retrospective design and residual confounding.</p> Conclusions and clinical implications <p>DAC exhibits more aggressive pathological features and higher biochemical persistence after RARP. These findings may warrant closer surveillance and further prospective studies to guide DAC-specific management strategies.</p> Patient summary <p>In this report, we compared outcomes after prostate cancer surgery in men with two types of prostate cancer: the common acinar type and the less common, more aggressive ductal type. We found that men with ductal prostate cancer had worse outcomes after surgery, including a higher chance of the cancer not being fully removed. These findings suggest that men with ductal prostate cancer may need closer monitoring and specialized treatment plans.</p>

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Comparing the outcomes of ductal versus acinar adenocarcinoma in patients undergoing robotic-assisted radical prostatectomy: propensity-matched analysis of a prostate cancer referral center

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • Sumeet Kumar Reddy,
  • Marcio Covas Moschovas,
  • Shady Saikali,
  • Rohan Sharma,
  • Ahmed Gamal,
  • Travis Rogers,
  • Marco Sandri,
  • Vipul Patel

摘要

Background and objective

Ductal adenocarcinoma (DAC) is the second most common subtype of prostate cancer and is believed to have more aggressive biology compared to acinar adenocarcinoma (AAC). This study aimed to compare pathological and oncological outcomes between DAC and AAC in patients undergoing robotic-assisted radical prostatectomy (RARP).

Methods

This was a single-center, retrospective cohort study of consecutive patients who underwent RARP between 2008 and 2023. Patients with DAC or AAC on final pathology were included. A 1:1 propensity score matching was performed based on key clinicopathologic variables. Primary outcomes included adverse pathological features, biochemical persistence, and biochemical recurrence (BCR). Statistical analyses included logistic regression and Cox proportional hazards models.

Key findings and limitations

Among 844 DAC and 14,357 AAC patients (median follow-up: 4.1 years), DAC was associated with higher extracapsular extension (48.2% vs. 35.4%, difference = 12.8%, 95% CI: 9.4–16.3, p < 0.001), biochemical persistence (8.3% vs. 4.4%, OR = 1.97, 95% CI: 1.52–2.56, p < 0.001), and BCR (20.1% vs. 12.5%, HR = 1.70, 95% CI: 1.44–2.01, p < 0.001). In the matched cohort, DAC had higher biochemical persistence (8.4% vs. 5.5%, OR = 1.58, 95% CI: 1.07–2.33, p = 0.03) but no differences in BCR or overall survival. Limitations include retrospective design and residual confounding.

Conclusions and clinical implications

DAC exhibits more aggressive pathological features and higher biochemical persistence after RARP. These findings may warrant closer surveillance and further prospective studies to guide DAC-specific management strategies.

Patient summary

In this report, we compared outcomes after prostate cancer surgery in men with two types of prostate cancer: the common acinar type and the less common, more aggressive ductal type. We found that men with ductal prostate cancer had worse outcomes after surgery, including a higher chance of the cancer not being fully removed. These findings suggest that men with ductal prostate cancer may need closer monitoring and specialized treatment plans.