Intraductal?

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Hi. My husband recently diagnosed with Intraductal carcinoma of prostate. Lesion Pirus 4 on MRI. Biopsy showed no invasive cancer cells. Oncologist was very reassuring and said very low grade and advised active surveillance. However, everything I read about Intraductal carcinoma describes it as associated with high grade and aggressive. I would like a second opinion but my husband has confidence with the Oncologist. It’s causing stress in our relationship. Does anyone know if I’m overreacting?

  • Hello  .

    Welcome to the group. I am sorry that you are in this situation and that it is causing stress in your relationship. I think I agree with you that a second opinion would be advisable. There seems to have been a lot of debate on when AS should progress to action and one of the triggers is if PIRADS 4 (I assume this is what has shown up). You are correct that the Intraductal Prostate Cancer has more aggressive characteristics which can lead to more rapid spread. The other issue is that it does not seem to respond well to hormone therapy or radiotherapy, so a prostatectomy would probably deal with it better - this is normally only suitable for fairly well contained cancers. One question I would ask the oncologist is - what % of men with non invasive Intraductal Prostate Cancer progress to needing treatment and over what time period. Also what % of these men have a curative outcome, and of those who don't then how are they treated, and what is the response rate with these alternative treatments - sorry, that is more than one question. 

    I have attached an interesting review on AS, but it does indicate that PIRADS 4 and Intraductal are triggers for moving from AS to treatment. I must stress that none of us are medically trained but maybe this is a question you should ask a nurse and I will tag  , our community champion, to give you the link. Also PCUK (Prostate Cancer UK) have a nurse who might be able to answer some of your questions.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10486407/

    As a group we are here to support each other and I hope that someone with more personal knowledge will be able to help you. Please come back with any questions.

  • And as if by magic here's the link

    Ask a Nurse 

    I am out at present but will put up a reply tomorrow.

    Best wishes - Brian.

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  • Hi S74 and a warm welcome from me. My PCa is intraductal, which only refers to whereabouts in the prostate the cancer originates, which as it is not within the prostate means it can be easier for the cancer to spread, but as most cancers are very slow growing this can take years, more important is your variant which you should ask about. I also agree with Alwayshope and you regarding a second opinion. Can i ask, diagnosis was it carcinoma or adenocarcinoma, take care.

    Eddie

  • Good Morning S74

    A warm welcome to the online Community from me - I am so sorry to find you here but it's a great place for help and advice. I was having a family day out yesterday - hence my short reply.

    I fully agree in your case with what both  and  have posted. I think on a personal opinion if I had your husband's diagnosis I would be wanting some action - I would not want to wait and give the cancer any extra time to go "walkabout".

    I can understand your husband having confidence in his oncologist - let's face it in our lives we don't see many oncologists so you tend to agree with what they say and as a consultant you do trust them - however you do have the choice to change.

    The best information regarding change of consultant comes in this leaflet attached - although it's printed by one specific health authority the guidance applies throughout  the entire NHS.

    chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/www.cntw.nhs.uk/.../Change-of-consultant-LP-2022.pdf

    I don't think you are overreacting, you are looking after his best interests - if I can do anything else for you please let me know.

    Keep us posted as to how you and your husband progress with his treatment.

    Best wishes - Brian.

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    Macmillan Support Line - 0808 808 00 00, 7 days a week between 8am-8pm

    Strength, Courage, Faith, Hope, Defiance, VICTORY.

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  • The other thing to add is that you can go privately for a second opinion to review all the scans and tests. 

  • Thanks for your replies. We’re going for a private second opinion and to review scan & biopsy.

  • Thanks for the update, you have made the right decision, please let us know how you get on, best wishes.

    Eddie

  • Under the circumstances I think this is a wise decision. Please let us know the outcome and all the best.

  • I’m bumping this thread back up to the top because, in my opinion, you definitely need to consider treatment rather than AS. Intraductal carcinoma means that microscopic bits can break away from the main lesion and make their way to the lymphatic system - this is a bit like turning off a narrow bumpy farm road onto a motorway. However, your oncologist says “low grade”, so treatment is likely to be effective as it’s been identified at an early stage. Push HARD (politely) for another review by the MDT at the hospital, or go for a private appointment (preferably with an NHS consultant who does private work, as he or she will be able to easily access all your NHS information).  Please let us know how you get on.  AW

  • Morning  . S74 is getting a second opinion which is advisable and will hopefully get back to us with the verdict.