Periurethral prostatic duct carcinoma. Clinical features and treatment results

A retrospective review was conducted of 58 patients with periurethral prostatic duct carcinoma (PUPDC) seen at the Columbia‐Presbyterian Medical Center between 1965 and 1977. The mean age at diagnosis was 70.2 years. Forty‐five of 57 patients (79%) presented with symptoms of progressive prostatism, and 25 (44%) had gross hematuria. Eight patients (14%) presented in Stages A & B, 39 (67%) in Stage C and 11 (19%) in Stage D. Malignant cells were found in the urine in 9 of 10 patients. Hydronephrosis was present in 11 (20%). Eleven patients developed pulmonary metastases and 10 hepatic metastases; of 14 patients with osseous metastases, the lesions were osteolytic in 10 (71%). Serum and bone marrow acid phosphatase, and serum alkaline phosphatase enzymatic determinations were inconsistent in patients with this tumor. The overall 5‐year survival rate was 36.9%. Stage A and B patients appeared to have a good prognosis; however the 5‐year survival rate in Stage C was only 34.5%. Stage C patients treated initially with radiotherapy had better local control rates (13/17 = 76%) and better 5‐year survival rates (58%) than those who did not receive this treatment (14% local control rate and 24% 5‐year survival rate). The effect of hormonal manipulations on local control and on survival was variable. Of 12 patients failing locally after nonradiotherapeutic initial management, 10 (83%) were controlled locally with radiotherapy. Local recurrence occurred in 2 of 5 stage A patients who did not receive treatment other than their original simple prostatectomy (which had revealed their tumor). There is no evidence that this tumor is intrinsically radioresistant; yet treatment failures, both local and distant after radiotherapy, are more common and occur earlier with PUPDC than with acinar adenocarcinoma. None of the therapeutic modalities appeared very successful in averting distant failure. Because of its local and distant aggressiveness and because of the population it afflicts, PUPDC rarely is amenable to radical surgery. Radiotherapy becomes the treatment of choice for majority of patients and should be aggressive both in dose and irradiated volume. Cancer 42:2894–2902, 1978.