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Intraductal prostate carcinoma: What is standard treatment?

Posted by dodgerblue @dodgerblue, May 1, 2023

Seems this diagnosis is rare. E Does anyone know what the “standard of treatment” t” is the best approach to this issue?

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heavyphil | @heavyphil | May 21 8:18am
In reply to @mlabus3 "I'll join the confused and frustated crowd. Shocked at the lack of interest and/or specific treatment..." + (show)
@mlabus3

I'll join the confused and frustated crowd. Shocked at the lack of interest and/or specific treatment plan by both Hopkins radiologists and surgeons to my IDC diagnosis. (my first pathology was 3 core "evidence" of possible IDC. I had a second path acknowledged expert who said "extensive IDC". ) However radiologist still considers me a intermediate unfavorable (i now consider it high risk and have asked for a more aggressive plan), and surgeon is actually directing me to radiation. Based on what I ahve researched however, it seems to me RP is the preferred solution. I am going to join the xanax crowd shortly. It becomes all-consuming and immensely frustrating. Just reached out to Mayo, but i know that will take months, time which i dont feel I have. My kingdom for a thoughtful IDC treatment plan. PS 3+4 with one 4+3, and 70 YO.

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Well, the newest literature seems to indicate that the best prognosis for any intraductal (cribriform) findings is surgery followed by radiation/ADT.
Yes, it’s a lot, but with your very high Decipher, the outcome is very scary if you don’t go all in with treatment.
Phil

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1 reply
mlabus3 | @mlabus3 | May 21 11:06am
In reply to @heavyphil "Well, the newest literature seems to indicate that the best prognosis for any intraductal (cribriform) findings..." + (show)
@heavyphil

Well, the newest literature seems to indicate that the best prognosis for any intraductal (cribriform) findings is surgery followed by radiation/ADT.
Yes, it’s a lot, but with your very high Decipher, the outcome is very scary if you don’t go all in with treatment.
Phil

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whats the "newest literature"? would like to review!

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2 replies
heavyphil | @heavyphil | May 21 12:18pm
In reply to @mlabus3 "whats the "newest literature"? would like to review!" + (show)
@mlabus3

whats the "newest literature"? would like to review!

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I posted it on your previous thread on today’s board…you’ve probably seen it already.
Phil

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surftohealth88 | @surftohealth88 | May 21 8:01pm
In reply to @mlabus3 "I'll join the confused and frustated crowd. Shocked at the lack of interest and/or specific treatment..." + (show)
@mlabus3

I'll join the confused and frustated crowd. Shocked at the lack of interest and/or specific treatment plan by both Hopkins radiologists and surgeons to my IDC diagnosis. (my first pathology was 3 core "evidence" of possible IDC. I had a second path acknowledged expert who said "extensive IDC". ) However radiologist still considers me a intermediate unfavorable (i now consider it high risk and have asked for a more aggressive plan), and surgeon is actually directing me to radiation. Based on what I ahve researched however, it seems to me RP is the preferred solution. I am going to join the xanax crowd shortly. It becomes all-consuming and immensely frustrating. Just reached out to Mayo, but i know that will take months, time which i dont feel I have. My kingdom for a thoughtful IDC treatment plan. PS 3+4 with one 4+3, and 70 YO.

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We finally had consultations at center of excellence in our area and both prostate surgeon and radiologist agreed that RP is the best course of action in our case. My husband has only one 4+3 core with IDC and cribriform. He is 69 and will be 70 in autumn. His Decipher score is 100 (yes, 100). Radiologist said that aggressive findings require an aggressive approach and that there is only one more aggressive treatment than radiation and that is RP. My husband is in very good health and still very active, so age was not an issue for making decision.
Wishing you the best with whatever you decide.

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1 reply
dailyeffort | @dailyeffort | May 21 9:21pm
In reply to @mlabus3 "whats the "newest literature"? would like to review!" + (show)
@mlabus3

whats the "newest literature"? would like to review!

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Hi @mlabus3

You have probably already been through all of the online studies, but just in case here are some links to studies on IDC=P . I found the findings significant and might help you arrive at a treatment decision. At the very least after reviewing these, you should have some very detailed questions for the RO and surgeon.
Bill

Prognostic value of intraductal carcinoma subtypes and postoperative radiotherapy for localized prostate cancer
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01690-1#:~:text=According%20to%20the%20Epstein%20criteria%20and%20the,2%E2%80%94solid%20or%20dense%20cribriform%20structures%20%5B14%2C%2015%5D.
Enrichment of “Cribriform” morphologies (intraductal and cribriform adenocarcinoma) and genomic alterations in radiorecurrent prostate cancer
https://www.sciencedirect.com/science/article/pii/S0893395222002629#:~:text=Herein%2C%20we%20analyzed%20radiorecurrent%20cases,relative%20to%20the%20pretreatment%20state.

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heavyphil | @heavyphil | May 22 7:46am
In reply to @surftohealth88 "We finally had consultations at center of excellence in our area and both prostate surgeon and..." + (show)
@surftohealth88

We finally had consultations at center of excellence in our area and both prostate surgeon and radiologist agreed that RP is the best course of action in our case. My husband has only one 4+3 core with IDC and cribriform. He is 69 and will be 70 in autumn. His Decipher score is 100 (yes, 100). Radiologist said that aggressive findings require an aggressive approach and that there is only one more aggressive treatment than radiation and that is RP. My husband is in very good health and still very active, so age was not an issue for making decision.
Wishing you the best with whatever you decide.

Jump to this post

Are you going to follow RP with radiation/ADT or watch and wait?
Phil

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