Clinical characteristics, treatment patterns, and survival outcomes in ductal prostate cancer: a multicenter retrospective analysis

Abstract

Abstract Purpose Prostatic ductal adenocarcinoma (PDA) is a rare, aggressive prostate cancer subtype associated with advanced disease and poorer prognosis than acinar adenocarcinoma. Small ductal components influence management and preclude active surveillance. This study analyzed oncologic outcomes and therapeutic patterns in a multicenter German cohort. Methods Retrospective multicenter cohort, seven high-volume German centers. 82 patients with histologically confirmed PDA diagnosed 2014–2024 included. Histopathological data from biopsy and radical prostatectomy (RP) specimens. Clinical data: local/systemic treatments, follow-up until 2025. Primary outcome: time to systemic therapy. Secondary: overall survival. Predictors of adverse outcomes assessed via Cox regression. Results Most patients presented with d’Amico high-risk (47/82, 57.3%) or intermediate-risk (28/82, 34.2%) disease; 9.8% (8/82) had synchronous metastases. RP performed in 82.9% (68/82), radiotherapy in 7.3% (6/82). Postoperative lymph node positivity and positive surgical margins occurred in 25.0% (17/68) and 22.1% (15/68), respectively. Median follow-up was 36 months (IQR 20–54 months). At the time of analysis, overall survival and cancer-specific survival were immature, with a limited number of events during follow-up. Among patients who required systemic therapy during follow-up, the median interval from local treatment to initiation of systemic therapy was 23 months (IQR 5–31 months). High pre-/postoperative Gleason scores (≥ 8) were associated with earlier initiation of systemic therapy. Among patients receiving systemic treatment ( n = 24), ADT monotherapy showed longer median duration (27.2 months) than ARPI (10.9 months) or chemotherapy (6.1 months). Limitations: retrospective design, limited sample size. Conclusion PDA demonstrates aggressive behavior with early need for systemic therapeutic escalation in a substantial proportion. High Gleason scores were associated with earlier initiation of systemic therapy. These findings suggest that PDA should be considered a high-risk entity. However, survival outcomes require longer follow-up for definitive conclusions.