Newly dx. PCa. with Intraductal carcinoma, IDC-P. This is the most aggressive prostate cancer type. In my case 4+3 with 70% pattern 4 with cribriform which make it even more worse. There are four types of pattern 4 (poorly formed glands, glomeruloid structures, cribriform glands, and fused glands) and the presence of cribriform glands is associated with an aggressive clinical course compared with other architectural subtypes.
I am reading that the IDC-P has poor response to ADT, CT (chemo), and external beam radiation.
Anyone who has news on recent/upcoming medications, clinical trials or alternatives to existing ones?
"..........Recent clinical studies report that IDC-P is associated with neoadjuvant androgen deprivation therapy (ADT) and, chemotherapy (CT) failure as well as early disease recurrence after external beam radiation. Finally, IDC-P is associated with TMPRSS2-ERG gene fusion, which was reported to be regulated by estrogens and their receptors........."
"Conclusion: The study showed that IDC-P is prevalent in aggressive prostate cancer and contains cells that can withstand androgen deprivation. Thus, IDC-P appears functionally relevant in advanced prostate cancer. The presence of IDC-P may be a trigger to develop innovative clinical management plans."
Do not overblow its importance. It makes your grade more risky than it would otherwise be. So your GS4+3 (grade Group 3) should be treated as if it were (Grade Group 4). Things like higher dose radiation, wider treatment areas, and intensified hormone therapy with 2nd gen hormonals may be appropriate.
A Gleason 10 is more aggressive. Intraductal PCa spreads faster than non-intraductal PCa, but responds to hormone therapy as well as non-intraductal PCa. I would avoid intermittent ADT but you can take breaks using Bicalutamide instead of Lupron.
I have G9, intraductal, luminal type B. PNI, cribiform. Responded excellent to Enza, PSA to 0.03. Three years later, rechallenged with Enza after BAT, PSA from 7.3 down to 0.5 even my AR is of the V7 type.
If you have IDC, often implies BRCA2, then Olaparib works effectively. Important to perform a NGS to see which mutations you have.
Please see my profile. I am also G9!with Intraductal and cribiform histology with PNI and SVI. I’m T3bN1. So far my pca has responded well to HDR Brachytherapy with EBRT boost and ADT with Lupron and abiraterone. PSA is now <0.05. I am also BRCA2 leaving PARP inhibitors as an option. I am currently two years out from starting treatment.
Much appreciated for your respond. Yes and very glad that ADT is effective. There are other ADT combination, second generation, etc. Added you and will follow you up.
I don't agree that intraductal is not responding to ADT. I was diagnosed with tubalar Prostate Cancer, also called ductal prostate cancer. It is cancer that starts in the tube that runs from the bladder, through the prostate gland, you pee with it. The building of these cancer cells are also cylindric, not round as normal prostate cancer cells. The cancer is fast and aggressive, spread quickly, is known for very high PSA counts. Statistics show that you have about 60% life expectancy of normal PC. Only 5% make it to year 8. And yet, here I am. Yes by the grace of God. By a tough oncologist who put me on Lucrin and gave me the green light to used Coartem, and a comprehensive cancer diet. With a PSA of 0.187 and no more mets. So don't give up hope. Be positive and seeks for the best treatment available. Kind Regards, Thinus Coetzee
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Dr. Sperling ECE article, not encouraging
Article: Androgen Deprivation Therapy Exposure Linked to Increased Risk of Dementia After Prostate Cancer 
Surgery + Radiation for Advanced PCa Offers Better Survival than RT + xRT 
