Ductal prostate cancer is a rare subtype of prostate cancer that is often diagnosed in later stages than other types.

The National Cancer Institute estimates that almost 290,000 men will receive a diagnosis of prostate cancer in the United States in 2023. More than 90% of prostate cancers are classified as acinar adenocarcinoma, which tends to be slow growing and usually has a good outlook.

Ductal adenocarcinoma prostate cancer, or simply ductal prostate cancer, is a rare subtype of prostate cancer that tends to be more aggressive than acinar adenocarcinoma, according to research from 2021. It’s usually associated with a later stage and higher mortality.

In a 2021 review of studies, researchers estimated that ductal prostate cancer makes up 0.17% of prostate cancers. Despite how rare it is, it’s thought to be the second most common type of prostate cancer.

Ductal prostate cancer tends to be diagnosed at a later stage than acinar adenocarcinoma. Doctors often treat it in the same way as high risk acinar adenocarcinoma, with some combination of:

Read on to learn more about this rare type of prostate cancer and how it differs from acinar adenocarcinoma.

The majority of ductal prostate cancers cause lower urinary tract symptoms. These symptoms can include:

Many people have advanced prostate cancer by the time they receive a diagnosis. Signs of advanced prostate cancer depend on where the cancer spreads, but they can include:

Learn more about prostate cancer symptoms.

As with most cancers, researchers don’t know exactly why some people develop ductal prostate cancer.

Cancer happens when genetic changes cause your cells to replicate out of control. It’s likely that a combination of your genetics and environmental factors plays a role in these genetic changes.

Researchers have identified certain genetic changes that are common in people with ductal prostate cancer. For example, a fusion of TMPRSS2 and ERG is identified in 10-50% of cases.

Prostate cancer becomes more common with age. In a 2022 study, researchers found that half of the people who had received a diagnosis of ductal prostate cancer were over age 68.

Other risk factors for prostate cancer include having a family history of prostate cancer or being of African American and Caribbean men of African ancestry, according to the American Cancer Society.

Learn more about prostate cancer risk factors.

Ductal prostate cancer is more likely to be diagnosed at a later stage than acinar adenocarcinoma. Cancer that spreads to distant body parts becomes harder to treat.

In the 2021 review of studies mentioned above, researchers found that ductal adenocarcinoma spread to distant body parts at the time of diagnosis 4.62 times more often than acinar adenocarcinoma.

Prostate cancer can cause many concerns if it spreads beyond the prostate. The specific complications it causes depend on where it spreads. They might include:

Doctors use a variety of tests to diagnose prostate cancer, such as:

Ductal prostate cancer can be difficult to identify using conventional diagnostic tools such as serum PSA and MRI scans. A biopsy is usually needed to confirm the diagnosis and to differentiate ductal prostate cancer from other types.

Ductal prostate cancer is usually treated like high risk acinar adenocarcinoma. The most common treatments are:

  • a type of surgery called radical prostatectomy and radiation therapy for prostate cancer confined to the prostate
  • androgen deprivation therapy with chemotherapy for cancer that’s spread to distant body parts

Researchers are continuing to examine the potential benefits of newer treatment options like immune checkpoint inhibitors.

Learn more about prostate cancer treatment.

Doctors have improved their understanding of ductal prostate cancer over the years. Researchers now know that it’s an aggressive subtype of prostate cancer, with poorer outlook than acinar adenocarcinoma.

In the 2021 review of studies, researchers found that the chances of surviving ductal acinar carcinoma 5 years after surgery were 74.7%, compared to acinar adenocarcinoma’s 87.9%.

In a 2022 research review, researchers found that the percentage of people with ductal prostate cancer who lived 3 and 5 years after their diagnosis were 84% and 67%, respectively.

Here are some frequently asked questions people have about ductal prostate cancer:

How fast does ductal prostate cancer grow?

Ductal prostate cancer tends to grow quickly and act aggressively, compared with acinar adenocarcinoma of the prostate. In the 2022 review mentioned earlier, researchers found that about 16% of people died within 3 years of receiving a diagnosis of ductal prostate cancer.

What is the difference between acinar and ductal prostate cancer?

Acinar and ductal adenocarcinoma cells look different when examined under a microscope. For example, ductal cancer cells tend to appear column-like, while acinar adenocarcinoma cells tend to appear more cubic.

What’s the difference between ductal and intraductal prostate cancer?

The terms “ductal prostate cancer” and “intraductal prostate cancer” are often mixed up. Intraductal carcinoma of the prostate gland refers to a tumor within large ducts of the prostate. Ductal adenocarcinoma refers to cancers that have the features of ductal prostate cancer under a microscope.

Ductal prostate cancer is a rare type of prostate cancer that tends to be more aggressive than the most common type of prostate cancer, called acinar adenocarcinoma. It’s more often diagnosed in a later stage and tends to spread to distant body parts quicker.

Doctors often treat ductal prostate cancer with surgery and radiation therapy for cancers limited to the prostate. Chemotherapy and hormone therapy are often used to treat cancers that have spread to distant body parts.