Optimizing the diagnosis and management of ductal prostate cancer

Weranja Ranasinghe, Daniel D. Shapiro, Miao Zhang, Tharakeswara Bathala, Nora Navone, Timothy C. Thompson, Bradley Broom, Ana Aparicio, Shi Ming Tu, Chad Tang, John W. Davis, Louis Pisters, Brian F. Chapin

Research output: Contribution to journalReview ArticleResearchpeer-review

16 Citations (Scopus)


Ductal adenocarcinoma (DAC) is the most common variant histological subtype of prostate carcinoma and has an aggressive clinical course. DAC is usually characterized and treated as high-risk prostatic acinar adenocarcinoma (PAC). However, DAC has a different biology to that of acinar disease, which often poses a challenge for both diagnosis and management. DAC can be difficult to identify using conventional diagnostic modalities such as serum PSA levels and multiparametric MRI, and the optimal management for localized DAC is unknown owing to the rarity of the disease. Following definitive therapy for localized disease with radical prostatectomy or radiotherapy, the majority of DACs recur with visceral metastases at low PSA levels. Various systemic therapies that have been shown to be effective in high-risk PAC have limited use in treating DAC. Although current understanding of the biology of DAC is limited, genomic analyses have provided insights into the pathology behind its aggressive behaviour and potential future therapeutic targets.

Original languageEnglish
Pages (from-to)337-358
Number of pages22
JournalNature Reviews Urology
Issue number6
Publication statusPublished - Jun 2021
Externally publishedYes

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