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. 2025 May;85(7):659-669.
doi: 10.1002/pros.24869. Epub 2025 Mar 4.

The Prognostic Value of the Prostate Adenocarcinoma With Ductal Feature in Patients With Advanced Prostate Cancer Treated With Abiraterone Acetate

Yifu Shi  1 , Xinyuan Wei  1 , Fengnian Zhao  1 , Junru Chen  1 , Guangxi Sun  1 , Xingming Zhang  1 , Jiayu Liang  1 , Xu Hu  1 , Pengfei Shen  1 , Zhenhua Liu  1 , Ling Nie  2 , Ni Chen  2 , Jinge Zhao  1 , Hao Zeng  1
Affiliations

The Prognostic Value of the Prostate Adenocarcinoma With Ductal Feature in Patients With Advanced Prostate Cancer Treated With Abiraterone Acetate

Yifu Shi et al. Prostate. 2025 May.

Abstract

Background: The prognostic value of the prostate adenocarcinoma (PAC) with ductal feature in patients with advanced prostate cancer treated with abiraterone acetate has not been scrutinized. This study aims to explore the predictive value of PAC with ductal feature on the therapeutic efficacy of abiraterone therapy in metastatic prostate cancer (mPCa) patients.

Methods: We retrospectively analyzed data from 569 patients with mPCa receiving abiraterone at either the metastatic hormone-sensitive (mHSPC, N = 165) or castration-resistant prostate cancer (mCRPC, N = 404) stage. PSM was performed to balance the baseline characteristics between individuals with and without ductal features. Kaplan-Meier curves and Cox regression were used to analyze the predictive significance of ductal feature on abiraterone efficacy, including PSA response, PSA progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS).

Results: Totally, ductal feature was detected in 40/569 (7.0%) men, with 18 and 22 in the mHSPC and mCRPC cohorts, respectively. The PSA response rate was comparable for people with and without ductal features for both cohorts. Notably, in the mHSPC cohort, patients with and without ductal features shared similar median PSA-PFS (not reached vs. 32.6-months, p = 0.593) and rPFS (not reached vs. 35.0-months, p = 0.768). Similar results were observed in the mCRPC cohort (median PSA-PFS: 21.2- vs. 11.6-months, p = 0.100; median rPFS: 34.6- vs. 18.7-months, p = 0.092). COX regression further revealed that ductal feature was not an indicator of unfavorable PSA-PFS or rPFS in the mHSPC and mCRPC cohort.

Conclusion: In conclusion, our findings indicated that there is insufficient evidence to differentiate the therapeutic efficacy of AA in mPCa based on the presence or absence of ductal features. However, further validation through larger-scale studies is required to substantiate them.

Keywords: abiraterone; mCRPC; mHSPC; prostate adenocarcinoma with ductal feature.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The predictive effect of ductal feature positivity on PSA response of the abiraterone treatment in mHSPC (A) or mCRPC (B) patients. mCRPC, metastatic castration‐resistant prostate cancer; mHSPC, metastatic hormone‐sensitive prostate cancer; PSA, prostate‐specific antigen. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Kaplan−Meier curves of PSA‐PFS, rPFS, and OS for mHSPC patients with and without ductal feature. (A−C) PSA‐PFS, rPFS, and OS before PSM; (D–F) PSA‐PFS, rPFS, and OS after PSM. mHSPC, metastatic hormone‐sensitive prostate cancer; OS, overall survival; PSA‐PFS, PSA progression‐free survival; rPFS, radiographic progression‐free survival. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Kaplan−Meier curves of PSA‐PFS, rPFS, and OS for mCRPC patients with and without ductal feature. (A−C) PSA‐PFS, rPFS, and OS before PSM; (D−F) PSA‐PFS, rPFS, and OS after PSM. mCRPC, metastatic castration‐resistant prostate cancer; OS, overall survival; PSA‐PFS, PSA progression‐free survival; rPFS, radiographic progression‐free survival. [Color figure can be viewed at wileyonlinelibrary.com]
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