Leukocytic Infiltration of Intraductal Carcinoma of the Prostate: An Exploratory Study

SIMPLE SUMMARY: Men with a particular type of prostate cancer, called intraductal carcinoma of the prostate (IDC-P), are more likely to die from their cancer than men without IDC-P. No researchers have yet compared the immune infiltrate of IDC-P to the immune infiltrate of prostate cancer. In this study, we quantified immune cells specifically in IDC-P and compared the cell densities in IDC-P to those in the adjacent cancer, tumor margins and benign tissues. We found that the immune infiltrate of IDC-P was generally reduced compared to the surrounding tissues, especially regarding antigen-presenting cells. Following validation in larger cohorts, the characterization of the immune microenvironment of IDC-P could allow a better understanding of the immune response to lethal prostate cancer and enable the development of new therapies. ABSTRACT: Intraductal carcinoma of the prostate (IDC-P) is an aggressive histological subtype of prostate cancer (PCa) detected in approximately 20% of radical prostatectomy (RP) specimens. As IDC-P has been associated with PCa-related death and poor responses to standard treatment, the purpose of this study was to explore the immune infiltrate of IDC-P. Hematoxylin- and eosin-stained slides from 96 patients with locally advanced PCa who underwent RP were reviewed to identify IDC-P. Immunohistochemical staining of CD3, CD8, CD45RO, FoxP3, CD68, CD163, CD209 and CD83 was performed. For each slide, the number of positive cells per mm(2) in the benign tissues, tumor margins, cancer and IDC-P was calculated. Consequently, IDC-P was found in a total of 33 patients (34%). Overall, the immune infiltrate was similar in the IDC-P-positive and the IDC-P-negative patients. However, FoxP3(+) regulatory T cells (p < 0.001), CD68(+) and CD163(+) macrophages (p < 0.001 for both) and CD209(+) and CD83(+) dendritic cells (p = 0.002 and p = 0.013, respectively) were less abundant in the IDC-P tissues compared to the adjacent PCa. Moreover, the patients were classified as having immunologically “cold” or “hot” IDC-P, according to the immune-cell densities averaged in the total IDC-P or in the immune hotspots. The CD68/CD163/CD209-immune hotspots predicted metastatic dissemination (p = 0.014) and PCa-related death (p = 0.009) in a Kaplan–Meier survival analysis. Further studies on larger cohorts are necessary to evaluate the clinical utility of assessing the immune infiltrate of IDC-P with regards to patient prognosis and the use of immunotherapy for lethal PCa.