Intraductal Carcinoma of the Prostate

[Willie51]

My biopsy indicates a tumor that’s Gleason 5+4=9, Group 5 (possibly still contained) with intraductal carcinoma. There seems to be only a small bit of Gleason 3+3=6 Group1 on the other side of the prostate. MRI a didn’t show any spread outside prostate. Biopsy is just released so full diagnosis, possible treatment discussions, and second opinions should happen next week.

My research seems very grim. I’m devastated but trying to hold some hope. Does anyone have information about survival relative to this ? Thanks

[Tall_Allen]

You have to have a PSMA PET/CT to eliminate the possibility of distant metastases. If that is negative, there is no reason you cannot be cured.

The most curative option is Brachy boost therapy = external beam to a wide area covering the pelvic lymph nodes + brachytherapy to the prostate + 1 year of ADT.

[Willie51 in reply to Tall_Allen]

Thanks I do appreciate hearing that from you. I’m pushing very hard to do all that you and others have recommended but it’s still slow going.

[Willie51 in reply to Tall_Allen]

Going back to this post. My recent PET scan showed 2 lymph nodes clavicle area. I’m seeing my Dr first time after scan today. How do these distant metastases change my best treatment plan and outcomes in your opinion?

[Tall_Allen in reply to Willie51]

Unfortunately, those lymph nodes are outside of the curative area. You can still get them zapped. You can still get brachy boost therapy (whole pelvic external beam radiation (assume there is microscopic cancer in the pelvic lymph nodes too), brachytherapy to the prostate, and hormone therapy. The hormone therapy should consist of ADT + Zytiga/Xtandi/Erleada.

Hopefully, the debulking plus the metastasis-directed therapy plus the hormone therapy will prevent progression for a long time.

[Firstglantz]

Sorry to hear you’re having to go thru this. I’m 54 and had virtually the same diagnosis last year (Gleason 9, group 5, intraductal, some spread outside, stage 3, 1 positive regional node). I was told to remain positive, that at least 15 more years (if not more) of survival should be expected, that there was a 75-82% chance of it returning. Interestingly, because of it being intraductal, which doesn’t always raise the PSA, my follow ups should include imaging every six months.

Even though PSMA PET/CT scans are popular for this, and I’ve had a couple, my oncologist said they can alternate with traditional scans since PSMA scans haven’t been shown to be THAT much better than traditional.

I was very discouraged when they told me and I read the grim information about it, but my perspective has changed since they’ve emphasized it is still a relatively slowly growing type of cancer and there are treatments for it should it recur. Hang in there!!

[Willie51 in reply to Firstglantz]

Wow. Your reply was exactly what I’d been looking for, particularly the intraductal part. I’m still waiting to see my URO/ONO this Thursday ( if I can’t move it up) . It’s been a nerve racking trial ever since it started with an elevated score of 6.4 late in October ‘23. Also 4 mos later I’m still waiting to finally hear from my (highly recommended) Dr this week to review my biopsy reports which I got thru my PCP and we’re pretty devastating. Did a lot of research. Report was bad enough but everything I could find about intraductal sounded positively deadly. Does it add such a difficult outcome to the prognosis? I’m kind of Type A personality so can’t sit still and waiting without even a plan is excruciating. My doc has been out of town for a week. Best news you gave me was that even the more aggressive introductal is still slow growing! Hadn’t been able to find that info. HIs there anything else you can tell me about intraductal in treatment or outcomes ( over and above the Gleason 4+5 ). Tall Allen has made good recommendations for treatment and second opinions. I’m 73 and had already had a partial prostalectomy a few years ago to increase urine flow. To be honest that cut back sex ability quite a bit more that my original dumbass URO let on. I’m married with a great younger husband. Many people here are most worried about sex (important) but I’m most worried about staying alive. I appreciate any advice. Thanks!

[billy1950]

Hi Willie,

I know somewhat with what you are dealing with. In 2004 i was treated with EBRT. Had a PSA 6.9 and gleason 3+3.

Now almost 20 years later in 2021 my biopsy showed a BCR with intraductal. Had my slides additionally read by Dr. Epstein at John Hopkins…I got on the internet and possibly read some of the same info as you. In saying how deadly and aggressive it is. Since initially having radiation in 2004, i didn’t want to get it treated with more radiation ( HD brachytherapy) was recommended at Memorial Sloan Kettering).

None of the 4 or 5 docs who i have talked with about it would be treating it any differently than any other kind of BCR. I have mentioned to my RO about the low PSA coming from intraductal. So far i have only been on ADT for 6 months which lowered the psa to almost zero…

No one can tell when it first developed…i have my next Psa is in July. The MRI shows that it is contained in prostate. i did read somewhere that intraductal stays in the prostate…how long who knows.

So far the PSMA shows no cancer anywhere else…

I understand your stress…been somewhat anxious from 2021. lol. However, seeing a psychologist ( specialty cancer) at the local hospital has helped. i stopped seeing him after 2 years…( btw, i just turned 74)…All we can do is to try not to dwell on it…My therapy taught me to get on with life, possibly doing something new…BTW, congratulations in having a younger husband! 👍

[Willie51 in reply to billy1950]

PC really is a long and difficult journey. (I hope mine is as long as yours). Good luck . My only unfortunate comment is regarding intraductal PC staying in the prostate. My first diagnosis after the PET scan already showed it having spread to these lymph nodes. As I now understand this could have been years in the making (even though my PSA was tested annually). I’m on Lupron + Abiraterone and starting radiation in a couple weeks. My PSA went from 8.6 to .5 in 3-4 weeks. But now should I think this might not be a true indicator because of the intraductal factor. When I bring “intraductal” up to my doctors they always say the Gleason 9 is the determining factor.