Intraductal prostate carcinoma: What is standard treatment?

My husband's biopsy was reread by MSK and one of the cores said the following, "Focally suspicious for intraductal carcinoma (separate core)." He has been diagnosed with stage 4A prostate cancer with one pelvic lymph node involvement that I have written about here. Moving ahead with ADT then internal and external radiation. What does this new diagnosis of 'intraductal carcinoma mean for his treatment, cure etc? TIA

What type of ADT? Chemical or surgical?

@cheriekhan, I moved your question about intrductal prostate carcinoma to this existing discussion:
- Intraductal prostate carcinoma: What is standard treatment?
https://connect.mayoclinic.org/discussion/intraductal-prostate-carcinoma/
I did this so you can read the previous posts and connect with others with this type of prostate cancer. You might also appreciate this related discussion:
- Proton beam vs IMRT for intraductal carcinoma of the prostate
https://connect.mayoclinic.org/discussion/proton-beam-verses-imrt/
What ADT medication will be used?

Thank you.

I didn't learn that I have intraductal PC until my recurrence about 10 months after surgery in late-2018. My surgeon never mentioned it. As mentioned above, I was also told that it was a more aggressive form of PC and that it only effected a low single-digit % of men. While having a Gleeson of 4+3=7, my PSA never rose above 2.0 before my surgery. I was told that I was part of a rare group for this as well (not sure if any relation to the type of PC).

I had surgery at Northwestern, then used my local Denver urologist for radiation treatment. I wish at this point I had gone to Dr. Kwon at Mayo, which is where I started treatment after the PC came back after radiation. I believe we should have waited to do radiation until the scan showed the exact location, rather than just radiate the prostate bed. My advice is also to seek the best treatment facility, even if you have to travel, as these care centers are much better versed on the latest tech and PC research has come a long way, even over the last 5 years. Dr. Kwon/Dr. Davis did spot radiation to a lymph node and I am coming off 18 months of ADT. The hope is for a cure or at least kicking the can down the road until the next treatment. Doing pescatarian diet (see the new studies that have come out this year on plant-based diets and PC) and 45+ minute of exercise everyday. Should probably drink less wine and cook more at home, but life needs to be enjoyed!

Hope this helps. I wish you the very best!

I think Ductal is the rare form of PC - intraductal is more common I believe but not noted on many pathologies?

Update from Spryguy:
I am now 3 yrs from diagnosis.
PSA is undetectable. I am off of Zytiga, Prednisone, and the Lupron is starting to wear off.
Dr Moore (Mayo Oncologist) is calling it remission. Working on weight and dealing with fatigue (Nap everyday for an hour) and the dam(n) hot flashes.
So mostly GOOD outcome with some negatives thrown in. I hope all you guys can have at least this kind of outcome. God Bless

Same her - my husband got this diagnosis last week in one of his biopsy plugs. At first I thought it just means 1 to 2 % chance of it spreading ( that is what urologist said) and was almost hopeful that we will get this beast under control, this or that way, especially if PSMA PET CT does not show spread but after finding time to read specifically about IDC entity I almost lost it last night . OMG, can it be more complicated and with less direction than this ??? I read somewhere in the wee hours of sleepless night that like half of IDC do respond to hormonal treatment and half do not. I was in daze so I do not even know what paper/ study was that. Actually I am sure it was not real study, just observation , it seems nobody studies this particular oddity. I think I will have to take a day off reading stuff just to stay sane here. I will be of no help to my husband if I fall apart.

I read last night that even doctors sometimes do not distinguish those two things. So I am not even sure what my husband has at this point . His report says :
"1 core involved by prostatic adenocarcinoma, gleason grade 4+3 (grade group 3). Gleason pattern 4 comprises 80% of the core and consisted of poorly formed glands with developed cibriform gland. Gleason 4 includes intraductal component .Perineural invasion and extraprostatic extension are absent.

This was the only core of 14 total taken that has this. Only 3 more have some changes and they are 3+3 .