Intraductal prostate carcinoma: What is standard treatment?

@colleen young
Thank you for your post. After almost 12 years of active surveillance on a 3+3 cancer, this diagnosis has been very frustrating. I appreciate your taking the time to respond. Intraductular cancer is so hard to find information on. Not sure it exists.

It exists. I have it. It's not good. It's dangerous.
In my case, since the cancer has spread to my entire skeleton, surgery would be irrelevant and radiation would kill me, so I'm on Lupron and abiraterone.
It's been about 17 months now and I'm doing well.

I’m speechless. You have my respect for being a fighter. I’m having a prostatectomy next week. Thus far, as near as a Psma petscan shows, it has not metastasized. Not looking forward to this. I’m sure it’s gonna be a long journey. I’ve read and been told it may, MAY, not be hormone fed. I’m going to rely on my medical oncologist, all I can do.

Keep fighting Pauljay!

You're physician or team should be able to tell you what the recommended treatment is based on the most current research and data, and what the mortality rate is. They literally input your diagnostic results into a grid and it spits out the recommendation or options.

I am 57 and had a radical prostatectomy last fall (Gleason 7 - 4/3). Based on my experience, I would highly recommend a radical prostatectomy. When you chose to do the RP at a center of excellence like Mayo-Rochester, they have the latest tools/procedures (robotic assisted surgery, nerve sparing, etc.). For me, the most uncomfortable part of the surgery related to referred shoulder pain (from expansion gas) and the catheter. It took about a week for the shoulder pain to reside and my catheter was removed after a week as well. in my case, I wanted to get the cancer out of my body and did not want to rely on imperfect tools/scans to track any remaining cancer within my body (if it was localized). Fortunately, post surgery pathology indicated that the cancer did not spread. I now feel confident that I have done everything possible to rid my body of this cancer. However, I am a realist - The cancer could come back because of micro-metastasis (time will only tell).

For me, the most aggressive choice (RP) was the only logical choice - 57, healthy, life expectancy (without active cancer) hopefully 30+ years, willing to put up with potential negative side effects (impotence, incontinence) Fortunately, I have done well with side effects, but I have been aggressive in rehabilitation habits. However, everyone has to make their own decision based on personal life expectations - Life estimate, willingness to put up with side effects, etc.

Good luck with your decision and I pray all goes well with whatever path you choose.

Johns Hopkins also noted intraductal and "some large cribriform" on my 2nd opinion. My current urologist hasn't really given much weight to it and said it "doesn't change your course of treatment" . I'm really confused and conflicted over this and not sure how to proceed.

@rickp1, what treatment will you be having?

Intraductal (IDC-P) treatment options after RP
64 y.o. - PSA 4, five biopsies positive, Gleason 4+3 = 7, elected RP (procedure performed 11/1) - post-op pathology indicated presence of IDP, invasion of both seminal vesicles and one lymph node (8 lymph nodes removed). Started ADT 1-week post-op (Lupron) - referred to radiologist. Not a lot of available info on IDC-P post-RP. What is state-of-the-art treatment (radiology, type of beam, etc) and your experience (if applicable)? Thanks in advance.

@dmd1atl, you're right that there's less information about intraductal prostate cancer. I'm moved your post to this discussion about this type of cancer:
- Intraductal prostate carcinoma: What is standard treatment?
https://connect.mayoclinic.org/discussion/intraductal-prostate-carcinoma/

I did this so you can read previous posts and connect with members like @robertkerr @dodgerblue @spryguy @pauljay @hammer101 @rickp1 to ask questions.

Has you team suggested which treatment would be best for you? Are you looking for a second opinion?

Dodgerblue here. Last 5 months have been very stressful. I’ll try to shorten it. I was trying to pick from surgery versus radiation for intraductal cancer. Strangely, radiation oncologist suggested surgery, my surgeon suggested radiation because of my age(75) and potential side affects. Second opinion from a leader in robotic surgery suggested since a Psma pet scan indicated I was clear, other than the prostate, he would suggest surgery. Acknowledging, “Yes, I am a surgeon but you will never definitively know what you are dealing with, unless you have surgery to remove and have it analyzed.” He said he had seen Intraductal, but it never ORIGINATED in the prostate. I had surgery and the pathology report came back showing aggressive, high level cancer, but no INDICATION of “INTRADUCTAL carcinoma”. All indications are it was contained within the capsule. Yes, I have side affects (progressing!), but 2 psa blood tests have come back as “non detectable”. I realize this most likely is not the end of the journey, but I am so thankful for what I’m calling divine intervention. I appreciate this forum and will continue to monitor it closely and although I don’t know any of you personally, but my almost 13 year journey and many, many hours spent in a local support group keep me focused and my thoughts and prayers will continue “all of youse directions.”