Key Clinical MessageThis case emphasizes the challenges in diagnosing and treating Prost ...
Key Clinical Message
This case emphasizes the challenges in diagnosing and treating Prostatic Duct Adenocarcinoma, especially in resource-limited settings. Early and accurate diagnosis is crucial for better patient outcomes, but limited access to advanced diagnostics and specialized treatments significantly hinders the effective management of this aggressive form of prostate cancer.
1 INTRODUCTION
Prostate cancer is becoming an increasingly serious health issue in Africa, with rising rates of illness and death. This trend is especially evident in Uganda.1 Prostatic ductal adenocarcinoma (PDA), a rare and aggressive form of prostate cancer, originates in the large primary periurethral prostatic ducts, and poses a higher risk of progression and spreading to other organs.2, 3 Although PDA is the second most common subtype of prostatic carcinoma, it makes up only a small percentage of cases, with acinar adenocarcinoma accounting for over 90% of all primary prostatic carcinomas.4 PDA is frequently found alongside the more common acinar carcinoma, indicating that it may sometimes develop in conjunction with the prevalent acinar adenocarcinoma subtype.2
2 CLINICAL PRESENTATION
PDA often displays distinct clinicopathological and radiological characteristics that can be difficult to detect before surgery.5 Patients usually exhibit urinary obstructive symptoms, hematuria, and are frequently diagnosed during transurethral resection.6 These tumors typically grow as outward lesions into the urethra, particularly around the verumontanum.6-8 PDA is marked by gross hematuria or urinary obstructive symptoms such as delayed urination, nocturia, and dribbling.8, 9 Ductal adenocarcinoma cases often present with advanced disease and are poorly differentiated exhibiting unique metastatic patterns, commonly spreading to both bone and visceral organs. Ranasinghe et al. noted that while bone metastases in PDA are similar to acinar adenocarcinoma, lung metastases occur more frequently, rising from 23.2% in de novo cases to 44.2% post-treatment.10, 11 Vinjamoori et al. further identified atypical metastases in PDA, with the lungs and pleura affected in 40%, the liver in 37%, and supradiaphragmatic lymph nodes in 34% of cases.12 Bergamin et al. also observed that PDA often metastasizes to unusual sites, such as the lungs, even at low prostate-specific antigen (PSA) levels.13 These findings emphasize PDA's aggressive and unpredictable metastatic behavior.
3 INVESTIGATIONS
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