This paper aims to:

Review the most important clinical and epidemiological aspects of prostatic ductal adenocarcinoma.

Discuss the relevant histopathological features of prostatic ductal adenocarcinoma, emphasizing those that are determinants of imaging patterns.

Review clinical cases of prostatic ductal adenocarcinoma, including clinical presentation and imaging approach.

Discuss the main findings of prostatic ductal adenocarcinoma on multiparametric MRI.

Prostate cancer is the second most common neoplasm in men, with prostatic acinar adenocarcinoma (AAC) accounting for approximately 90% of cases. Prostatic ductal adenocarcinoma (DAC), the second most common histological variant, accounts for only 2.6-6.3% of all prostate cancers, including both pure ductal and mixed ductal-acinar adenocarcinomas.

DAC tends to have a more aggressive behavior than acinar adenocarcinomas, as they respond poorly to conventional therapies and often require multimodal therapy. They usually affects men over 55 years old, and may present with hematuria and voiding symptoms when the lesion is periurethral.

DAC is associated with lower levels of prostate-specific antigen (PSA), higher stage, higher risk of biochemical recurrence and higher mortality rate. They can...

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We present 7 cases from our institution, 5 mixed ductal-acinar and 2 pure ductal adenocarcinomas, aiming to demonstrate the pathological findings with corresponding image patterns. As the systematic investigation of these tumors is limited by the rarity of these lesions, it is essential that the radiologist is familiar with this diagnosis, allowing more agility in the diagnosis, clinical management and follow-up of these patients.