Does prostatic ductal adenocarcinoma exist?

Prostatic ductal (endometrioid) adenocarcinoma has been considered a distinct pathologic and clinical entity since it was first described more than 30 years ago. Its current status as a unique neoplasm is controversial, however, because it has considerable histologic overlap with typical acinar adenocarcinoma, particularly in small specimens such as needle biopsies. There are also conflicting views regarding its clinical behavior. We recently encountered a series of typical peripheral zone cancers of the prostate gland with prominent papillary or cribriform pattern that apparently did not involve the large periurethral prostatic ducts or verumontanum. To determine the incidence of these "ductal features" in nonductal carcinoma, we reviewed the findings in 338 consecutive totally embedded whole-mount prostatectomy specimens with typical clinical and pathologic features of acinar carcinoma. We defined carcinoma with significant "ductal features" as one that displayed papillary or cribriform pattern involving an arbitrarily defined aggregate focus at least 5 mm in diameter. Anti-keratin 34beta-E12 immunohistochemical staining for basal cells allowed exclusion of areas of papillary or cribriform pattern of high-grade prostatic intraepithelial neoplasia. We identified carcinoma with ductal features (papillary or cribriform growth) in 17 prostatectomy specimens (5% of cases) exclusively in the peripheral zone without involving the periurethral region. Papillary pattern was present in 11 of these cases (65%) and cribriform pattern in 10 (59%), including 4 cases (24%) with both patterns. Of 11 needle biopsy specimens available for examination from these 17 cases, 4 (36%) contained at least focal papillary or cribriform pattern of carcinoma. We conclude that adenocarcinoma arising in the peripheral zone of the prostate gland may display ductal carcinoma features (papillary or cribriform growth) classically associated with ductal adenocarcinoma. These findings, together with the recognized near-constant association of prostatic ductal adenocarcinoma and typical prostate cancer, suggest that ductal adenocarcinoma results from spread of typical prostatic acinar carcinoma into the large accommodating periurethral ducts and stroma, and that there are no unique histologic features other than site of growth. Identification of papillary or cribriform growth of cancer in prostate needle biopsies usually results from peripheral zone adenocarcinoma and not ductal adenocarcinoma.

Fat source and calcium level effects on finishing steer performance, digestion, and metabolism.

A 111-d finishing study evaluated animal growth and carcass characteristics using 138 steers (366 kg) in a randomized complete block design with a 2 x 3 factorial arrangement of treatments. The dietary treatments consisted of no supplemental fat or 3.5% tallow or soybean oil soapstock (SS) fed with .6% and .9% dietary Ca. Fat increased DMI (P less than .05) but interacted with Ca level (P less than .05) for gain/feed and ADG. All diets containing fat or .9% Ca were converted more efficiently to gain than the .6% Ca, no supplemental fat diet (P less than .05). The .9% Ca interacted with fat source to decrease gain (P less than .05) and tended to decrease efficiency in the tallow diet but improved efficiency (P less than .05) and tended to improve gain in the no-fat diet. In the SS diet, .9% Ca had no effect on ADG, DMI, or efficiency of gain. Fat addition increased backfat (P less than .10) and interacted with Ca on hot carcass weight, final weight, and dressing percentage (P less than .05). Feeding fat increased the proportion of 18:0 (P less than .02) and decreased the proportion of 16:1 fatty acids (P less than .06) in intermuscular fat. A replicated 3 x 3 Latin square design, using six Holstein steers (349 kg) fed three diets, with no supplemental fat or 3.5% SS or tallow with 1.0% Ca, was used to explore the effects of fat sources when fed with high Ca on digestion and metabolism. Ruminal fluid pH was higher (P less than .10) when steers were fed fat. Adding fat did not affect (P greater than .10) duodenal or ileal pH, VFA proportions or total concentration, or ruminal liquid volume or flow rate. Liquid retention time was shorter and liquid rate of passage was higher (P less than .05) with dietary fat addition. Adding fat did not affect site or extent of starch or DM digestion. There was net synthesis of 16:0, 18:0, and 18:1 fatty acids in the rumen. When steers were fed tallow, synthesis of 16:0 and 18:0 fatty acids in the rumen was lower (P less than .10) than when steers were fed SS. Feeding fat tended to decrease (P = .11) bacterial N flowing at the duodenum but did not affect nonbacterial N or total N. Fat addition seems to affect ruminal kinetics, and the effects may vary with fat source, particularly relative to fatty acid synthesis and digestion.

Mixtures of wheat and high-moisture corn in finishing diets: feedlot performance and in situ rate of starch digestion in steers.

Wheat and high-moisture corn (HMC) were fed singly and in three combinations using dry-rolled wheat (DRW) (ratios of 75:25, 50:50, and 25:75, respectively, Trial 1), or singly and in two combinations using steam-rolled wheat (SRW) (ratios of 67:33 and 33:67, respectively, Trial 2) to finishing beef cattle fed a high-concentrate diet. In situ rate of starch digestion (Trial 3) was measured on grains used in Trial 1 (excluding the 25 HMC: 75 DRW mixture) and ground dry corn. In Trial 1 (132 d), gain/feed did not differ (P greater than .10); however, final weight, hot carcass weight, and ADG decreased linearly (P less than .05) and DMI exhibited a cubic response (P less than .05) as the percentage of wheat in the diet increased. Carcass characteristics were not different. In Trial 2 (113 d), there were no differences attributable to treatment for ADG, DMI, gain/feed, or carcass characteristics. Positive associative responses for gain efficiency (gain/feed) were greatest for the first increment of wheat addition (25% DRW and 33% SRW in Trials 1 and 2, respectively) and for the early portion of the feeding period (57 and 28 d for Trials 1 and 2, respectively), indicating a more rapid diet adaptation and(or) less propensity for subacute acidosis. In Trial 3, the treatment grains or mixtures did not differ in rate of starch digestion. Although the differences were not statistically significant, starch in the 100% wheat diet was digested twice as fast as the 100 or 75% HMC mixtures.(ABSTRACT TRUNCATED AT 250 WORDS)

The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy.

PURPOSE: Pretreatment clinical staging of prostatic adenocarcinoma is important due to the increasing use of nonsurgical treatment options. Using multivariate analysis we assessed the predictive value of biopsy cores positive for cancer as a percent of all cores obtained as well as the percent surface area of needle cores involved with tumor for determining tumor volume and pathological stage at radical prostatectomy. Candidate variables for the multivariate model included patient age, clinical disease stage, serum prostate specific antigen (PSA) and Gleason score of cancer in the needle biopsy. MATERIALS AND METHODS: We reviewed prostate needle biopsy findings in 207 consecutive patients who subsequently underwent radical retropubic prostatectomy. Each biopsy specimen was assessed for tumor involvement by calculating the percent of cores positive for cancer, percent surface area involved in all cores and Gleason score. Initial serum PSA and preoperative clinical disease stage were incorporated with biopsy results into a multivariate model to determine the parameters most predictive of pathological stage and tumor volume at radical retropubic prostatectomy. RESULTS: Of the 207 patients 152 (73.4%) had organ confined cancer and 55 (26.6%) had extraprostatic extension (pathological stages T2 and T3 or greater, respectively). Preoperative clinical staging information was available in 195 cases, in which disease was clinically confined and not confined in 184 (94.4%) and 11 (5.6%), respectively. Needle biopsy revealed a surface area of cancer ranging from less than 5% in 69 patients (33.3%) to 90% (mean 16, median 10). Univariate analysis demonstrated that the risk of extraprostatic extension was predicted by preoperative serum PSA (p = 0.027), the percent of cores and percent of surface area positive for cancer (p <0.0001), and Gleason score (p = 0.0009). Clinical stage approached significance (p = 0.071). Multivariate analysis showed that the percent of positive cores (p = 0.0003), initial serum PSA (p = 0.005) and Gleason score of cancer in the needle biopsy (p = 0.03) were the only parameters that jointly predicted pathological stage (T2 versus T3). Percent of tumor surface area involvement in the needle biopsies did not add any more information after the percent of positive cores was known. Univariate analysis revealed that the percent of cores positive for cancer (Spearman r = 0.52, p <0.0001), Gleason score (Spearman r = 0.34, p <0.0001) and initial serum PSA (Spearman r = 0.24, p = 0.003) were predictive of log tumor volume at radical prostatectomy, while clinical stage was not (rank sum test p = 0.14). On multivariate analysis the percent of positive cores (p <0.0001), Gleason score (p <0.0001) and initial serum PSA (0.0033) were the only variables that jointly were predictive of tumor volume. CONCLUSIONS: The percent of needle biopsy cores and surface area positive for cancer are the strongest predictors of pathological stage and tumor volume on multivariate analysis incorporating preoperative serum PSA and Gleason score.