Hatice BÖLEK, Satı Coşkun YAZGAN, Emre YEKEDÜZ
Bulletin of Urooncology - 2026;25(1):18-26
Objective: This study aimed to evaluate the prognostic impact of intraductal carcinoma of the prostate (IDC-P) in patients with metastatic prostate cancer treated with enzalutamide or abiraterone acetate. Materials and Methods: We retrospectively analyzed data from patients with metastatic prostate cancer who received abiraterone acetate or enzalutamide. The primary outcome was overall survival (OS). Secondary outcomes were prostate-specific antigen (PSA) progression-free survival (PFS) and radiologic PFS. Results: A total of 94 men were enrolled in the study. Among them, 30 patients (31.9%) received androgen receptor pathway inhibitors for metastatic hormone-sensitive prostate cancer (mHSPC), and 64 patients (68.1%) were treated for metastatic castration-resistant prostate cancer (mCRPC). The presence of IDC-P was associated with significantly shorter OS than in patients without IDC-P (35.38 months vs. 55.59 months, respectively; p=0.011). In mCRPC, median OS was significantly shorter in patients with IDC-P (35.38-55.59 months), while the difference was not significant in the mHSPC cohort [35.48 months vs. not reached (NR)]. Multivariate Cox regression analysis identified IDC-P as an independent adverse prognostic factor for OS (hazard ratio 3.16, 95% confidence interval 1.56-6.41; p=0.001). Similarly, median PSA-PFS was significantly shorter in patients with IDC-P than in those without IDC-P (15.87 vs. 31.11 months, p=0.020). In mCRPC, median PSA-PFS was significantly shorter in patients with IDC-P (15.9 vs. 28.4 months), whereas the difference was not significant in the mHSPC cohort (18.3 months vs. NR). Conclusion: The presence of IDC-P is associated with poorer PSA-PFS and OS in patients with metastatic prostate cancer treated with abiraterone acetate or enzalutamide.
