Does the presence of ductal adenocarcinoma change how you risk stratify or treat patients with localized prostate cancer?

Ductal adenocarcinoma (DAC) of the prostate is a distinct, but rare (< 1%) subtype of prostate adenocarcinoma. DAC originates from primary periurethral prostatic ducts or in the peripheral prostatic ducts. Because of its predominantly periurethral location, it may present with hematuria, urgency, and retention and is missed by rectal examination. DAC tends to be aggressive and metastasizes to unusual locations such as in the penis and peritoneum. (Ranasinha et al., PMID 35474657). Despite its aggressive behavior, the current practice is to treat DAC stage-by-stage as conventional prostate adenocarcinoma. A recent study showed high DECIPHER scores in cribriform variant of DAC (along with intraductal carcinoma-another aggressive subtype of pr...