Any experience with Intraductal Cancer?

[SherpaT]

Not sure how this works. Hopefully you can read my profile to see where I'm at. If not, I repeat it here. My GP recommended biopsy after several annual PSA results around 4.0 Was on active surveillance since diagnosis in 2019 with biopsy Gleason 6 in two cores. Similar result in annual biopsies in 2020, and 2021. Dec 2022 biopsy showed 2 cores positive but one was Gleason 3+4. PSA had risen to 5.7, but then dropped to 5.4 and 5.0. I elected to remain on active surveillance since PSA was stable, DRE's showed enlargement but no extension, and the small number of cores positive. CAT and Bone tests showed no evidence of disease. Therefore the December of 23 biopsy was a shock to me, as there were now 5 cores positive, 1 with Gleason 4+3, 1 with 3+3, not too surprising, but 3 cores with "a focus of intraductal cancer", which I had never heard of, not Gleason scored but assumed to mean higher grade cancer present. I have a PSMA-PET scheduled and will have some sort of treatment based on that outcome. I am looking at treatment for the prostate enlargement before anything else. I'm 73 and otherwise in excellent health and have no symptoms other than slow emptying.

[Don717]

IDC may present some treatment changes based on what you elect to treat the cancer with. However, generally speaking, it's nothing more than Adenocarcinoma found within the ducts of the biopsy of your prostate. It is a adverse feature that is indicative of an aggressive cancer. Typically, 4+3 or better. It's a subjective call for pathology. Much like PNI and other adverse additions to pathology. For example I've seen guys that had IDC diagnosed at biopsy but none found if they had RP in their surgical pathology. I had it in one pathology but not the other...go figure. I was diagnosed as Gleason 8 no adverse features at biopsy but then changed to 4+3 with IDC at my pathology after my RP. 2nd pathology at JH found no IDC but changed my 4+3 to a 4+4 still less than 10% of PV. I've been <.02 for the last 24 months after RP. I'm sure you are considering RT and the only thing this finding may change is the range of RT on your prostate. In other words, they may not want to do focal therapy and do whole gland. Others are way more advanced at this than I but I'm pretty sure you'd want to treat the cancer first, THEN the urinary issues. Good luck to ya...get some consults!!

[SherpaT in reply to Don717]

Thanks. Guess it just illustrates how "non standard" diagnosis is. You did help lessen my concern after reading in other places about 30% survival rates... Still need that PSMA/Pet before we decide where to proceed, but as of now, urologist suggest fix flow first, then cancer and RO seems okay with that. RO does want to do the hormone thing first and says prostate work doesn't affect that and standard full prostate radiation. and I'm not sure about that.

[Don717 in reply to SherpaT]

yeah it's very rare. Some pathology reports don't even include it anymore. Some nomograms either. When I referenced "treatment choice" I figured you were headed the RT route which I would do as well at your age. I didn't mean you'd consider RP. I talked with a guy who was considering HIFU and because his biopsy included IDC his doc said no. So that's what I meant by "treatment choice". I didn't mean to trigger anyone. Good luck on your PSMA sir!!

[Tall_Allen]

IDC-P is only an elevated risk factor when associated with high grade prostate cancer. Fortunately, you don't fall into that category. You are unfavorable intermediate risk.

The following nomogram shows the probability that surgery will be curative:

mskcc.org/nomograms/prostat...

As you can see, there is only a 59% chance that surgery will remain curative for at least 10 years (this doesn't consider IDC-P).

You can improve your odds with radiation. With SBRT, your odds improve to 85%:

prostatecancer.news/2018/10...

Your best odds are with high dose rate brachy boost therapy:

prostatecancer.news/2017/05...

For the boost part of the treatment, high dose rate brachytherapy has a milder side effect profile than low dose rate brachytherapy.

You may also wish to consider the following clinical trial that uses darolutamide:

clinicaltrials.gov/study/NC...

[SherpaT in reply to Tall_Allen]

Thanks for the information. I'll check these out. Your take on the BPH? Urologist does TURP, Laser and Urolift. Flow test upcoming. Again waiting for PSMA-Pet mid February. Still waiting to see if approved by my Medicare advantage plan, but hope I'm okay on that.

[SherpaT]

Thanks for input. I'll do some type of radiation. I read intraductal is an indicator of likelihood of spread, thus the ordered PSMA/Pet scan. Good last year on other scans. Was hoping 3+3 would continue for a few more years, but now I know I have to move on this. Big problem for me right now is mental adjustment required to take on side effects, doctors offices, insurance , for something when I feel good and I can't tell I have anything. My head says my life is at stake, my body doesn't know it.

[lpol83712]

I had Gleason 4+3 at Hopkins and significant BPH. You are generally better to treat BPH first then the Ca. The better procedures have a significant increased risk of incontinence if done after radiation. I had a HOLEP procedure and 10 weeks later MR directed SBRT. The HOLEP was easy recovery and appeared to be better than TURP if the surgeon is very experienced in HOLEP which is technically challenging.