ArticleInternational urology and nephrology2026
Comparing the outcomes of ductal versus acinar adenocarcinoma in patients undergoing robotic-assisted radical prostatectomy: propensity-matched analysis of a prostate cancer referral center.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectiveDuctal adenocarcinoma (DAC) is the second most common subtype of prostate cancer and is believed to have more aggressive biology compared to acinar adenocarcinoma (AAC). This study aimed to compare pathological and oncological outcomes between DAC and AAC in patients undergoing robotic-assisted radical prostatectomy (RARP).
methodsThis was a single-center, retrospective cohort study of consecutive patients who underwent RARP between 2008 and 2023. Patients with DAC or AAC on final pathology were included. A 1:1 propensity score matching was performed based on key clinicopathologic variables. Primary outcomes included adverse pathological features, biochemical persistence, and biochemical recurrence (BCR). Statistical analyses included logistic regression and Cox proportional hazards models. KEY FINDINGS AND LIMITATIONS: Among 844 DAC and 14,357 AAC patients (median follow-up: 4.1 years), DAC was associated with higher extracapsular extension (48.2% vs. 35.4%, difference = 12.8%, 95% CI: 9.4-16.3, p < 0.001), biochemical persistence (8.3% vs. 4.4%, OR = 1.97, 95% CI: 1.52-2.56, p < 0.001), and BCR (20.1% vs. 12.5%, HR = 1.70, 95% CI: 1.44-2.01, p < 0.001). In the matched cohort, DAC had higher biochemical persistence (8.4% vs. 5.5%, OR = 1.58, 95% CI: 1.07-2.33, p = 0.03) but no differences in BCR or overall survival. Limitations include retrospective design and residual confounding. CONCLUSIONS AND CLINICAL IMPLICATIONS: DAC exhibits more aggressive pathological features and higher biochemical persistence after RARP. These findings may warrant closer surveillance and further prospective studies to guide DAC-specific management strategies. In this report, we compared outcomes after prostate cancer surgery in men with two types of prostate cancer: the common acinar type and the less common, more aggressive ductal type. We found that men with ductal prostate cancer had worse outcomes after surgery, including a higher chance of the cancer not being fully removed. These findings suggest that men with ductal prostate cancer may need closer monitoring and specialized treatment plans.
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