© 1991 S. Karger AG, Basel 0302-2838/91/0191-0008$2.75/0
Eur Urol 1991;19:8-11
Carcinoma of Prostatic Ducts
1603433
C.D. Vera-Donoso*, J. Vidal*, S. Gómezb, F. Garclab, J. Gallegoa, B. Llopisa, J.F. Jiménez-Cruz a Service of Urology, and b Department of Pathology, La Fé Hospital, Valencia, Spain
Key Words. Prostatic-duct carcinoma • Adenocarcinoma, acinar • Cell carcinoma, ductal, transitional Abstract. Carcinoma of prostatic ducts is a rare clinical feature. We have reviewed 398 histories of patients with histologic diagnosis of prostatic carcinoma and found 10 patients with the ductal variety (2.51 %). Four had pure ductal transitional cell carcinoma, 5 had mixed acinar adenocarcinoma plus ductal transitional cell carcinoma, and the last one had mixed acinar and ductal adenocarcinoma. Age, symptoms, physical findings, and imaging diagnoses were similar to those of acinar carcinoma. Rectal examination disclosed hard prostate in 9 patients. The metastatic way depended on the histologic elements present in each patient. Cystoscopy showed a malignant-resembling image in 4 cases. The mean survival (23 months) was lower than that of patients with acinar carcinoma. Early diagnosis and radical surgery still are the only way to increase the expectation of life of patients affected by this pathology.
It is accepted that carcinoma arising from prostatic ducts has an incidence ranging between 1 and 5 % of all malignant prostatic tumors. However, it has been postu lated that this type is underreported. Its biological be havior seems to be different from the large group of aci nar carcinoma of the prostate, and therefore, it requires a different therapeutic approach. These reasons have moved us to review our cases of ductal carcinoma of the prostate.
Patients and Methods Between 1970 and 1988, 398 patients with histopathologic diag nosis of prostatic cancer were treated in our Hospital. Ten out of them were diagnosed as having carcinoma of prostatic ducts and were therefore included in our study. One patient had had retro pubic prostatic adenomectomy 4 years before. Two had undergone previous transurethral resections of adenocarcinoma of the prostate. All of them had undergone intravenous urography and cystoscopy. Ultrasound and CT had been performed in 3 patients. The thera peutical approach and complications of treatment are summarized in table 1.
Results Ranging between 5 5 and 86 years, the mean age of our patients was 66.3 years. This age range is in accordance with that in most of the known series. It must be remarked that almost one half of our patients were in the sixth decade of life. However, the mean age of this group of patients is not different from that of patients with acinar cancer. All typical symptoms of prostatism were the most common complaints of our patients. Rectal examination suggested malignancy in almost all of them (9/10). Intravenous urography showed an elevation of the bladder base in 40% of patients, repercussion on the upper urinary tract in 20%, osteoblastic metastasis in 10%, and complete normality in 10% of cases. Ultra sound examinations were performed in 3 cases; 2 by the transrectal route and 1 transabdominally. In all the cases, a heterogeneous echogenic image of the prostate was observed. Infiltration of the seminal vesicles was seen in 1 patient. Three patients underwent axial CT. It revealed infiltration of the fatty periprostatic planes in 1 case and ureterohydronephrosis in the other 2. By endo scopic examination a mass resembling a polypus was Downloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
Introduction
Carcinoma of Prostatic Ducts
9
Table 1. Therapeutical approach and outcome of patients Present tumor
Extension
Treatment
Outcome
1
ductal transitional cancer + acinar adenocarcinoma
diffused osteoblastic métastasés
TUR, radiotherapy, orchiectomy
died; frequent hematuria, pulmonary métastasés; 14 months
2
nodular benign hyperplasia no métastasés with areas of chronic prostatitis and foci of transitional intraductal carcinoma in situ
TUR, radiotherapy
well; no symptoms 5 years later
3
ductal transitional cancer
no métastasés
TUR, radiotherapy
well 20 months postoperatively
4
ductal transitional cancer + acinar adenocarcinoma
no métastasés, local
TUR, radiotherapy
died; severe frequent hematuria; 8 months
ductal transitional cancer + acinar adenocarcinoma
no métastasés, local
TUR
well 9 months postoperatively
ductal transitional cancer + acinar adenocarcinoma
diffused osteoblastic métastasés
TUR, orchiectomy
died; 4 months
ductal transitional carcinoma
no métastasés
TUR, radiotherapy
died; actinic rectitis and cystitis; 10 months
no métastasés, local extension
TUR, laparotomy, died; perineal métastasés; radiotherapy, vesico-rectal fistula by RT; chemotherapy 15 months
mixed ductal and acinar adenocarcinoma
local T3 N (x)
TUR, orchiectomy
well; asymptomatic 24 months later
ductal transitional carcinoma + acinar adenocarcinoma
local N (+)
TUR, radiotherapy
died; posterior bladder invasion requiring cystectomy; pulmonary métastasés; 6 months
5
acinar adenocarcinoma 3 years before; orchiec tomy and 2 TUR
6
7
benign hyperplasia 4 years before; prostatectomy
8
previous hormonal therapy ductal transitional for 5 months without carcinoma relief of symptoms
9
10
acinar adenocarcinoma, TUR + orchiectomy
seen in the prostatic urethra in 2 patients. In another 2, the prostate had an infiltrated aspect, with ulcerations and superficial necrosis. Endoscopic appearance of be nign hyperplasia of the prostate was the finding in the other 2 cases. The cystoscòpic data of the remaining patients were unremarkable. Pathologic Findings
Previous transrectal biopsy had been performed in 6 patients. It had been positive for ductal transitional cell carcinoma in 4 and for acinar adenocarcinoma in the other 2. The definitive histologic diagnoses are summa rized in table 1.
Treatment
Two out of 4 patients diagnosed as having pure ductal transitional cell carcinoma and treated with TUR plus radiotherapy had the longest survival, but the other 2 presented quick worsening with frequent admissions at the hospital because of recurrent and severe hematuria despite a similar management. One of them underwent laparotomy in order to perform radical surgery, but it was unfeasible. Therefore, TUR combined with postop erative irradiation (6,000 rads) was performed. Partial remission was achieved, but later, the patient presented perineal métastasés and required another 2,000 rads, without evident improvement. Chemotherapy with vinDownloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
Patient Preceding tumor No. and treatment
Vera-Donoso/Vidal/Gómez/Garda/Gallego/Llopis/Jiménez-Cruz
blastine, fluoracil, and cyclophosphamide was also un successful. A vesicorectal fistula and the death of the patient at 15 months were the final result. Five patients with transitional plus acinar carcinoma underwent TUR. Orchiectomy was performed in all of them because of the adenocarcinoma constituent. Three received radiation with a slight increase in survival (14.8 and 6 months) but without improvement in the quality of life. The two nonirradiated patients survived 4 and 9 months, respectively. Finally, 1 patient with mixed ductal and acinar ade nocarcinoma underwent TUR plus orchiectomy and sur vived for 24 months. Follow-Up
Two patients had skeletal métastasés at the time of diagnosis. During follow-up, 2 patients developed pul monary métastasés and 1 presented perineal-skin métas tasés. The average survival was 23 months (follow-up ranging between 4 and 120 months).
Discussion Prostatic carcinoma may arise from the columnar epi thelial cells lining the prostatic acini (accounting for about 95% of all cancers of the prostate) or from the epithelial cells lining the primary and secondary ducts of the prostate (between 1 and 5 % of all cases). This second group contains several histologic variations (transitional or squamous cell carcinoma, adenocarcinoma, and en dometrioid carcinoma) individually or mixed [1-3]. The overall incidence of carcinoma of prostatic ducts in the present series (2.51 %) is similar to that in other reports [4-6]. The mean age at diagnosis is within the usual range of 65-70 years. The symptoms were those usually seen with prostatism. Rectal examination was a reliable sign in our series. However, some authors con sider it to be misleading [7, 8]. The level of serum acid phosphatase was increased in 3 patients with mixed ade nocarcinoma and transitional cell cancer, thus confirm ing the data in the literature, which recognize the normal values of this parameter in pure ductal cancer. Cystos copy strongly suggests the diagnosis in some reports [5, 9], but only 40% of our patients showed malignantresembling signs on imaging. The data given by IVP, ultrasound, and CT do not differ from those of common prostatic carcinoma. However, the definitive diagnosis depends on the faculty of the pathologist.
In order to analyse treatment and survival, we di vided our patients into three groups. The first group con sisted of the 4 patients with pure ductal transitional cell carcinoma. All of them were included in the TUR-plusradiation therapy and 1 also required chemotherapy. Two patients survived 60 and 20 months, respectively, without symptoms of clinical progression or recurrence. The other 2 patients survived for 10 and 15 months, respectively, 1 of them presenting local extension of the tumor. In summary, this tumor is not different from other urothelial carcinomas, and this could explain its peculiar way to metastasize and its high resistance against conventional therapy. It is hormonally indepen dent and thus, hormonal manipulation is uneffective (case No. 8). Slightly better survival rates have been achieved in other series with radical cystoprostatectomy plus ileal conduit. Perineal prostatectomy is not cura tive, and subsequent local growth is almost assured [6, 10-12]. Chemotherapy has been reported to increase the survival of these patients, and remission of métastasés wtih cisplatin alone or combined with cyclophospha mide and/or doxorubicin have been achieved [13, 14]. The second group consisted of patients with com bined ductal transitional cell carcinoma plus acinar ade nocarcinoma and has not been fully discussed in the lit erature yet. 50% of our patients belonged to this catego ry, a higher percentage than in other reports (Rhamy et al. [6]: 20%, Greene et al. [8]: 30%). Theoretically, a tri ple therapy (TUR + irradiation + androgenic surgical or chemical blockade) covers all the possibilities suggested by histologic composition of these tumors. But up to now, no long and good survival has been achieved with it. Finally, ductal adenocarcinomas of the prostate with only relative extent were studied. As they behave similar to common acinar carcinomas, they are susceptible to hormonal manipulation [4, 7, 9], Responsiveness to hor monal treatment is better if the tumor arises from the primary than from the secondary ducts. Recently, Chris tensen et al. [15] reported on 14 patients treated with radical prostatectomy, but their results are not encourag ing, as the stage and grade of cancer were more advanced than in acinar carcinoma. We conclude that patients with ductal transitional cell carcinoma alone or associated with adenocarcinoma of the prostate have a poor prognosis. Long survivals usually are not accompanied by good quality of life. The behavior and therefore the management of ductal and acinar adenocarcinomas are similar. The problem under consideration clearly has no easy solution, but early diagDownloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
10
Carcinoma of Prostatic Ducts
References 1 Bennet R, Edgerton E: Mixed prostatic carcinoma. J Urol 1973; 110:567-563. 2 Catalona W, Kadmon D, Martin S: Surgical considerations in treatment of intraductal carcinoma of the prostate. J Urol 1978; 120:259-261. 3 Melicow M, Uson A: A spectrum of malignant epithelial tumors of prostate gland. J Urol 1976; 115:696-700. 4 Greene L, Farrow G, Ravits J, et al: Prostatic adenocarcinoma of ductal origin. J Urol 1979;121:303-305. 5 Kopelson G, Harisiadis L, Romas N, et al: Periurethral prostatic duct carcinoma. Cancer 1978;42:2894-2902. 6 Rhamy R, Buchanan R, Spalding M: Intraductal carcinoma of prostate gland. J Urol 1973;109:457-460. 7 Dube V, Farrow G, Greene L: Prostatic adenocarcinoma of duc tal origin. Cancer 1973;32:402-409. 8 Greene L, Mulcahy J, Warren M, et al: Primary transitional cell carcinoma of the prostate. J Urol 1973;110:235-237.
9 Dube V, Joyce G, Kennedy E: Papillary primary duct adenocar cinoma of the prostate. J Urol 1972;107:825-826. 10 Greene L, O’Dea M, Dockerty M: Primary transitional cell car cinoma of the prostate. J Urol 1976;116:761—763. 11 Shenasky J, Guillenwater J: Management of transitional cell car cinoma of the prostate. J Urol 1972;108:462-465. 12 Wolfe J, Lloyd-Davies R: Management of transitional cell carci noma in the prostate. Br J Urol 1981;53:253-257. 13 Dexeus F, Logothetis C, Samuels M, Ayala A, Hossan E: Com plete responses in metastatic transitional cell carcinoma of the prostate with cisplatin regimens. J Urol 1987;137:122-125. 14 Mexanler S, Lee S, Bekhrad A: Transitional cell carcinoma of the prostate: Response to treatment with cisplatin and cyclophos phamide. J Urol 1983;131:975-977. 15 Christensen W, Steinberg G, Walsh PC, Epstein J: Prostatic duct adenocarcinoma: Findings at radical prostatectomy. J Urol 1990;143:305A.
Dr. C.D. Vera-Donoso Service of Urology La Fé Hospital Av. Campanar 21 E-46009 Valencia (Spain)
Downloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
nosis and radical surgery followed by irradiation therapy seems to be the treatment of choice for patients with any type of carcinoma of the prostatic ducts. Metastatic dis ease may be managed successfully with cisplatin.
11
Eur Urol 1991;19:8-11
Carcinoma of Prostatic Ducts
1603433
C.D. Vera-Donoso*, J. Vidal*, S. Gómezb, F. Garclab, J. Gallegoa, B. Llopisa, J.F. Jiménez-Cruz a Service of Urology, and b Department of Pathology, La Fé Hospital, Valencia, Spain
Key Words. Prostatic-duct carcinoma • Adenocarcinoma, acinar • Cell carcinoma, ductal, transitional Abstract. Carcinoma of prostatic ducts is a rare clinical feature. We have reviewed 398 histories of patients with histologic diagnosis of prostatic carcinoma and found 10 patients with the ductal variety (2.51 %). Four had pure ductal transitional cell carcinoma, 5 had mixed acinar adenocarcinoma plus ductal transitional cell carcinoma, and the last one had mixed acinar and ductal adenocarcinoma. Age, symptoms, physical findings, and imaging diagnoses were similar to those of acinar carcinoma. Rectal examination disclosed hard prostate in 9 patients. The metastatic way depended on the histologic elements present in each patient. Cystoscopy showed a malignant-resembling image in 4 cases. The mean survival (23 months) was lower than that of patients with acinar carcinoma. Early diagnosis and radical surgery still are the only way to increase the expectation of life of patients affected by this pathology.
It is accepted that carcinoma arising from prostatic ducts has an incidence ranging between 1 and 5 % of all malignant prostatic tumors. However, it has been postu lated that this type is underreported. Its biological be havior seems to be different from the large group of aci nar carcinoma of the prostate, and therefore, it requires a different therapeutic approach. These reasons have moved us to review our cases of ductal carcinoma of the prostate.
Patients and Methods Between 1970 and 1988, 398 patients with histopathologic diag nosis of prostatic cancer were treated in our Hospital. Ten out of them were diagnosed as having carcinoma of prostatic ducts and were therefore included in our study. One patient had had retro pubic prostatic adenomectomy 4 years before. Two had undergone previous transurethral resections of adenocarcinoma of the prostate. All of them had undergone intravenous urography and cystoscopy. Ultrasound and CT had been performed in 3 patients. The thera peutical approach and complications of treatment are summarized in table 1.
Results Ranging between 5 5 and 86 years, the mean age of our patients was 66.3 years. This age range is in accordance with that in most of the known series. It must be remarked that almost one half of our patients were in the sixth decade of life. However, the mean age of this group of patients is not different from that of patients with acinar cancer. All typical symptoms of prostatism were the most common complaints of our patients. Rectal examination suggested malignancy in almost all of them (9/10). Intravenous urography showed an elevation of the bladder base in 40% of patients, repercussion on the upper urinary tract in 20%, osteoblastic metastasis in 10%, and complete normality in 10% of cases. Ultra sound examinations were performed in 3 cases; 2 by the transrectal route and 1 transabdominally. In all the cases, a heterogeneous echogenic image of the prostate was observed. Infiltration of the seminal vesicles was seen in 1 patient. Three patients underwent axial CT. It revealed infiltration of the fatty periprostatic planes in 1 case and ureterohydronephrosis in the other 2. By endo scopic examination a mass resembling a polypus was Downloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
Introduction
Carcinoma of Prostatic Ducts
9
Table 1. Therapeutical approach and outcome of patients Present tumor
Extension
Treatment
Outcome
1
ductal transitional cancer + acinar adenocarcinoma
diffused osteoblastic métastasés
TUR, radiotherapy, orchiectomy
died; frequent hematuria, pulmonary métastasés; 14 months
2
nodular benign hyperplasia no métastasés with areas of chronic prostatitis and foci of transitional intraductal carcinoma in situ
TUR, radiotherapy
well; no symptoms 5 years later
3
ductal transitional cancer
no métastasés
TUR, radiotherapy
well 20 months postoperatively
4
ductal transitional cancer + acinar adenocarcinoma
no métastasés, local
TUR, radiotherapy
died; severe frequent hematuria; 8 months
ductal transitional cancer + acinar adenocarcinoma
no métastasés, local
TUR
well 9 months postoperatively
ductal transitional cancer + acinar adenocarcinoma
diffused osteoblastic métastasés
TUR, orchiectomy
died; 4 months
ductal transitional carcinoma
no métastasés
TUR, radiotherapy
died; actinic rectitis and cystitis; 10 months
no métastasés, local extension
TUR, laparotomy, died; perineal métastasés; radiotherapy, vesico-rectal fistula by RT; chemotherapy 15 months
mixed ductal and acinar adenocarcinoma
local T3 N (x)
TUR, orchiectomy
well; asymptomatic 24 months later
ductal transitional carcinoma + acinar adenocarcinoma
local N (+)
TUR, radiotherapy
died; posterior bladder invasion requiring cystectomy; pulmonary métastasés; 6 months
5
acinar adenocarcinoma 3 years before; orchiec tomy and 2 TUR
6
7
benign hyperplasia 4 years before; prostatectomy
8
previous hormonal therapy ductal transitional for 5 months without carcinoma relief of symptoms
9
10
acinar adenocarcinoma, TUR + orchiectomy
seen in the prostatic urethra in 2 patients. In another 2, the prostate had an infiltrated aspect, with ulcerations and superficial necrosis. Endoscopic appearance of be nign hyperplasia of the prostate was the finding in the other 2 cases. The cystoscòpic data of the remaining patients were unremarkable. Pathologic Findings
Previous transrectal biopsy had been performed in 6 patients. It had been positive for ductal transitional cell carcinoma in 4 and for acinar adenocarcinoma in the other 2. The definitive histologic diagnoses are summa rized in table 1.
Treatment
Two out of 4 patients diagnosed as having pure ductal transitional cell carcinoma and treated with TUR plus radiotherapy had the longest survival, but the other 2 presented quick worsening with frequent admissions at the hospital because of recurrent and severe hematuria despite a similar management. One of them underwent laparotomy in order to perform radical surgery, but it was unfeasible. Therefore, TUR combined with postop erative irradiation (6,000 rads) was performed. Partial remission was achieved, but later, the patient presented perineal métastasés and required another 2,000 rads, without evident improvement. Chemotherapy with vinDownloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
Patient Preceding tumor No. and treatment
Vera-Donoso/Vidal/Gómez/Garda/Gallego/Llopis/Jiménez-Cruz
blastine, fluoracil, and cyclophosphamide was also un successful. A vesicorectal fistula and the death of the patient at 15 months were the final result. Five patients with transitional plus acinar carcinoma underwent TUR. Orchiectomy was performed in all of them because of the adenocarcinoma constituent. Three received radiation with a slight increase in survival (14.8 and 6 months) but without improvement in the quality of life. The two nonirradiated patients survived 4 and 9 months, respectively. Finally, 1 patient with mixed ductal and acinar ade nocarcinoma underwent TUR plus orchiectomy and sur vived for 24 months. Follow-Up
Two patients had skeletal métastasés at the time of diagnosis. During follow-up, 2 patients developed pul monary métastasés and 1 presented perineal-skin métas tasés. The average survival was 23 months (follow-up ranging between 4 and 120 months).
Discussion Prostatic carcinoma may arise from the columnar epi thelial cells lining the prostatic acini (accounting for about 95% of all cancers of the prostate) or from the epithelial cells lining the primary and secondary ducts of the prostate (between 1 and 5 % of all cases). This second group contains several histologic variations (transitional or squamous cell carcinoma, adenocarcinoma, and en dometrioid carcinoma) individually or mixed [1-3]. The overall incidence of carcinoma of prostatic ducts in the present series (2.51 %) is similar to that in other reports [4-6]. The mean age at diagnosis is within the usual range of 65-70 years. The symptoms were those usually seen with prostatism. Rectal examination was a reliable sign in our series. However, some authors con sider it to be misleading [7, 8]. The level of serum acid phosphatase was increased in 3 patients with mixed ade nocarcinoma and transitional cell cancer, thus confirm ing the data in the literature, which recognize the normal values of this parameter in pure ductal cancer. Cystos copy strongly suggests the diagnosis in some reports [5, 9], but only 40% of our patients showed malignantresembling signs on imaging. The data given by IVP, ultrasound, and CT do not differ from those of common prostatic carcinoma. However, the definitive diagnosis depends on the faculty of the pathologist.
In order to analyse treatment and survival, we di vided our patients into three groups. The first group con sisted of the 4 patients with pure ductal transitional cell carcinoma. All of them were included in the TUR-plusradiation therapy and 1 also required chemotherapy. Two patients survived 60 and 20 months, respectively, without symptoms of clinical progression or recurrence. The other 2 patients survived for 10 and 15 months, respectively, 1 of them presenting local extension of the tumor. In summary, this tumor is not different from other urothelial carcinomas, and this could explain its peculiar way to metastasize and its high resistance against conventional therapy. It is hormonally indepen dent and thus, hormonal manipulation is uneffective (case No. 8). Slightly better survival rates have been achieved in other series with radical cystoprostatectomy plus ileal conduit. Perineal prostatectomy is not cura tive, and subsequent local growth is almost assured [6, 10-12]. Chemotherapy has been reported to increase the survival of these patients, and remission of métastasés wtih cisplatin alone or combined with cyclophospha mide and/or doxorubicin have been achieved [13, 14]. The second group consisted of patients with com bined ductal transitional cell carcinoma plus acinar ade nocarcinoma and has not been fully discussed in the lit erature yet. 50% of our patients belonged to this catego ry, a higher percentage than in other reports (Rhamy et al. [6]: 20%, Greene et al. [8]: 30%). Theoretically, a tri ple therapy (TUR + irradiation + androgenic surgical or chemical blockade) covers all the possibilities suggested by histologic composition of these tumors. But up to now, no long and good survival has been achieved with it. Finally, ductal adenocarcinomas of the prostate with only relative extent were studied. As they behave similar to common acinar carcinomas, they are susceptible to hormonal manipulation [4, 7, 9], Responsiveness to hor monal treatment is better if the tumor arises from the primary than from the secondary ducts. Recently, Chris tensen et al. [15] reported on 14 patients treated with radical prostatectomy, but their results are not encourag ing, as the stage and grade of cancer were more advanced than in acinar carcinoma. We conclude that patients with ductal transitional cell carcinoma alone or associated with adenocarcinoma of the prostate have a poor prognosis. Long survivals usually are not accompanied by good quality of life. The behavior and therefore the management of ductal and acinar adenocarcinomas are similar. The problem under consideration clearly has no easy solution, but early diagDownloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
10
Carcinoma of Prostatic Ducts
References 1 Bennet R, Edgerton E: Mixed prostatic carcinoma. J Urol 1973; 110:567-563. 2 Catalona W, Kadmon D, Martin S: Surgical considerations in treatment of intraductal carcinoma of the prostate. J Urol 1978; 120:259-261. 3 Melicow M, Uson A: A spectrum of malignant epithelial tumors of prostate gland. J Urol 1976; 115:696-700. 4 Greene L, Farrow G, Ravits J, et al: Prostatic adenocarcinoma of ductal origin. J Urol 1979;121:303-305. 5 Kopelson G, Harisiadis L, Romas N, et al: Periurethral prostatic duct carcinoma. Cancer 1978;42:2894-2902. 6 Rhamy R, Buchanan R, Spalding M: Intraductal carcinoma of prostate gland. J Urol 1973;109:457-460. 7 Dube V, Farrow G, Greene L: Prostatic adenocarcinoma of duc tal origin. Cancer 1973;32:402-409. 8 Greene L, Mulcahy J, Warren M, et al: Primary transitional cell carcinoma of the prostate. J Urol 1973;110:235-237.
9 Dube V, Joyce G, Kennedy E: Papillary primary duct adenocar cinoma of the prostate. J Urol 1972;107:825-826. 10 Greene L, O’Dea M, Dockerty M: Primary transitional cell car cinoma of the prostate. J Urol 1976;116:761—763. 11 Shenasky J, Guillenwater J: Management of transitional cell car cinoma of the prostate. J Urol 1972;108:462-465. 12 Wolfe J, Lloyd-Davies R: Management of transitional cell carci noma in the prostate. Br J Urol 1981;53:253-257. 13 Dexeus F, Logothetis C, Samuels M, Ayala A, Hossan E: Com plete responses in metastatic transitional cell carcinoma of the prostate with cisplatin regimens. J Urol 1987;137:122-125. 14 Mexanler S, Lee S, Bekhrad A: Transitional cell carcinoma of the prostate: Response to treatment with cisplatin and cyclophos phamide. J Urol 1983;131:975-977. 15 Christensen W, Steinberg G, Walsh PC, Epstein J: Prostatic duct adenocarcinoma: Findings at radical prostatectomy. J Urol 1990;143:305A.
Dr. C.D. Vera-Donoso Service of Urology La Fé Hospital Av. Campanar 21 E-46009 Valencia (Spain)
Downloaded by: University of Exeter 144.173.6.94 - 5/7/2020 10:36:32 AM
nosis and radical surgery followed by irradiation therapy seems to be the treatment of choice for patients with any type of carcinoma of the prostatic ducts. Metastatic dis ease may be managed successfully with cisplatin.
11
