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Julka et al. J Transl Genet Genom 2020;4:455-63 Journal of Translational
DOI: 10.20517/jtgg.2020.46 Genetics and Genomics

Case Report Open Access

Adenoid cystic carcinoma of the prostate: an
unusual subtype of prostate cancer

Pramod Kumar Julka *, Amit Verma *, Sanjay Gupta , Kush Gupta , Rahul Rathod 4
2,
1,
3
3
1 Department of Medical Oncology, Max Institute of Cancer Care, New Delhi 110024, India.
2 Department of Molecular Oncology, Max Institute of Cancer Care, New Delhi 110024, India.
3 Department of Clinical Operations, Catalyst Clinical Services Pvt. Ltd., New Delhi 110089, India.
4 Department of Medical Affairs, MitraRxDx India Pvt. Ltd, Bengaluru 560037, India.
*Equal contribution.
Correspondence to: Dr. Pramod Kumar Julka, Department of Medical Oncology, Max Institute of Cancer Care, Lajpat Nagar,
New Delhi 110024, India. E-mail: pkjulka18@yahoo.co.in; Dr. Amit Verma, Department of Molecular Oncology, Max Institute of
Cancer Care, New Delhi 110024, India. E-mail: amitverma.dr@gmail.com
How to cite this article: Julka PK, Verma A, Gupta S, Gupta K, Rathod R. Adenoid cystic carcinoma of the prostate: an unusual
subtype of prostate cancer. J Transl Genet Genom 2020;4:455-63. http://dx.doi.org/10.20517/jtgg.2020.46
Received: 10 Sep 2020 First Decision: 9 Oct 2020 Revised: 15 Oct 2020 Accepted: 3 Nov 2020 Available online: 13 Nov 2020

Academic Editor: Sanjay Gupta Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Adenoid cystic carcinoma (ACC) of the prostate is an extremely rare disease that arises from the basal cells of
prostate acini and presents a poor prognosis for metastatic cases. Multiple treatment options exist for different
stages of prostate cancer that include prostatectomy, radiation therapy, chemotherapy, and hormone therapy
with gonadrotropin-releasing hormone (GnRH) agonists and antagonists for androgen receptor (AR)-positive
cases. Although ACC has a biological potential that allows metastasis in a few cases; the current treatment option
consists primarily of surgical resection along with close, long-term follow-up. Herein, we report this rare entity in
a 79-year-old man who presented with liver metastasis. The tumor expressed GnRH receptor (GnRHR) and a very
low level of Programmed death-ligand 1 (PD-L1). Immunohistochemical analysis revealed that the primary tumor
was highly proliferative and AR-negative. We employed a clinically validated technology that utilizes patient's
tumor and blood to recreate the tumor microenvironment ex vivo. After the diagnosis, we used the platform to test
the efficacy of degarelix (a GnRHR antagonist), atezolizumab (a PD-L1 antagonist) and paclitaxel + carboplatin
chemotherapeutic regimen. The assay output predicted response with chemotherapeutics and degarelix, without
any sign of efficacy for PD-L1 antagonist. On the basis of these data, the patient was treated with paclitaxel +
carboplatin combination chemotherapy first and showed clinical and radiological response as predicted by the
ex vivo platform. After 4 cycles of chemotherapy, the patient received maintenance therapy with degarelix and
demonstrated a favorable clinical response. Taken together, our results not only showed the accurate prediction

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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