Radiotherapy With Hyperthermia for Prostatic Ductal Adenocarcinoma: Primary and Salvage Cases.

BACKGROUND/AIM: Prostatic ductal adenocarcinoma (PDA) is a rare and aggressive histological variant of prostate cancer associated with a high risk of treatment failure and poor survival compared to conventional acinar adenocarcinoma. We report three cases of PDA treated with radiotherapy combined with regional hyperthermia. CASE REPORT: Two patients with locally advanced PDA (cT3aN0M0) were treated with definitive intensity-modulated radiotherapy combined with regional hyperthermia. One patient with biochemical recurrence following radical prostatectomy (pT3aN0M0) received salvage three-dimensional conformal radiotherapy with regional hyperthermia. Therapeutic heating was achieved in all cases, with thermal doses (CEM43T90) of 5.2, 6.1, and 2.3 min, respectively. Long-term clinical control was observed in all patients, with follow-up durations of six, nine, and eight years, respectively. In the salvage case, a secondary prostate-specific antigen increase occurred but was successfully controlled with short-term hormonal therapy, with no subsequent clinical progression. CONCLUSION: Radiotherapy combined with regional hyperthermia may represent a promising treatment strategy for achieving durable clinical control in patients with PDA.