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ESMO 2018

ESMO 2018: The Prognostic Value of the Proportion and Subtype Patterns of Intraductal Carcinoma with De Novo Metastatic Prostate Cancer: A Propensity Score Matching Study

Munich, Germany ( UroToday.com) It is well established that the presence of intraductal carcinoma (IDC) of the prostate is an adverse prognostic factor, with respect to PSA failure, progression-free survival, and cancer-specific survival in patients with localized prostate cancer1. In a retrospective study of 206 patients who underwent radical prostatectomy in Japan, of the patients who had a clinical relapse, 79.5% had IDC in their pathology report. 20 patients had died of prostate cancer in follow up, of which 17 patients (85%) had IDC. This study was followed up with another which included 150 patients who presented with de novo metastatic prostate cancer2. Again, on multivariate analysis, intraductal carcinoma of the prostate was significantly associated with cancer-specific survival and overall survival (OS).

ESMO 2018 IDC stain

This study confirms the above findings reported by Kato et al. utilizing a larger patient population, with 644 de novo metastatic prostate cancer patients in the modern era from 2010-2017. Of the 644 patients, 28% had IDC.  Primary endpoints of this study were castration-resistant prostate cancer-free survival (CFS) and OS. Patients with more than 10% IDC were more than twice as likely to develop CRPC than patients with less than 10% IDC (HR: 2.27, p < 0.001) and more than twice as likely to die (HR: 2.63, p < 0.001). The other negative prognostic indicator was the pattern of IDC.

ESMO 2018 IDC survival graph

All patients with IDC were classified as either IDC Pattern 1 (loose cribriform or micropapillary) or IDC Pattern 2 (solid or dense cribriform). Patients with IDC pattern 2 also had worse CFS (HR: 1.98, p < 0.001) and OS (HR: 2.11, p = 0.003).

ESMO 2018 IDC P groups

Based on IDC pattern and IDC percentage, the authors were able to risk stratify patients into five distinct groups (Group 0 – Group 4), where patients in Group 0 were without IDC and had a median overall survival of 68.6 months, compared with patients in Group 4 which had the highest risk factors (IDC>10% and IDC Pattern 2) and had a median overall survival of 29.9 months. 

ESMO 2018 IDC survival double graph

This is an interesting study which demonstrates that IDC percentage and IDC pattern may help describe the patient heterogeneity that is present in patients who present with metastatic castration sensitive prostate cancer (mCSPC). It is unknown what the best sequence of therapies are for patients who present with mCSPC and both chemotherapy with docetaxel and second generation AR inhibitor abiraterone are approved in this indication. For very high-risk patients as described in this abstract (Group 4 – IDC>10% and IDC Pattern 2), these patients may benefit from a more aggressive treatment paradigm upfront given their disease biology.


Presented By: Jinge Zhao, PhD, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China

Written By: Jason Zhu, MD. Fellow, Division of Hematology and Oncology, Duke University Twitter: @TheRealJasonZhu at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23,  2018, Munich Germany

References:
1. Kimura K, Tsuzuki T, Kato M, et al. Prognostic value of intraductal carcinoma of the prostate in radical prostatectomy specimens. The Prostate 2014;74:680-7.
2. Kato M, Tsuzuki T, Kimura K, et al. The presence of intraductal carcinoma of the prostate in needle biopsy is a significant prognostic factor for prostate cancer patients with distant metastasis at initial presentation. Modern Pathology 2016;29:166.