J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 6, Number 3, June 2014, pages 157-161

Multidisciplinary Approach to Synchronous Prostate and Rectal Cancer: Current Experience and Future Challenges

**Table 1.** Presentation of Patients’ Demographics, Presenting Features, Histological Characteristics of the Prostate and Rectal Cancers, as Well as the Treatment Strategies Followed on Each Occasion and the Outcome of the Interventions
Authors	Age	Presenting feature(s)	Prostate cancer features	Rectal cancer features	Treatment	Postoperative complications	Outcome
Abbreviations: PSA: prostate specific antigen; DRE: digital rectal examination; APR: abdominoperineal resection; LAR: low anterior resection; LOS: length of stay.
Klee et al [7]	52	PSA 9.1 ng/mL	Gleason grade 7/10, stage T2C prostate adenocarcinoma right lateral wall	4 cm Duke’s stage B, moderately differentiated rectal adenocarcinoma	APR + radical rertropubic prostatectomy/blood loss 1,200 mL/operating time 4 h	Bowel obstruction and ischemic colostomy/LOS 16 days	At a minimum of 1 year of follow-up, all three patients had an undetectable PSA, and the rectal cancers remained in remission.
Klee et al [7]	70	PSA 5.9 ng/mL on routine rectal examination benign prostate, a left posterior lateral rectal wall mass	Gleason grade 6/10, stage T2A prostatic adenocarcinoma in right apex	2 cm Duke’s stage A, moderately differentiated rectal adenocarcinoma	APR + radical retropubic prostatectomy/blood loss 700 mL/operating time 3 h	Nil reported/LOS 8 days
Klee et al [7]	64	PSA 6.1 ng/mL, change of bowel habits, induration in left prostate base and PR bleeding in DRE	Gleason grade 7/10 adenocarcinoma in left side and in the right base	4.5 cm non-invasive villous adenoma without cancerous features	LAR + radical retropubic prostatectomy/blood loss 1,100 mL/operating time 2.25 h	Rectal and bladder neck stricture/LOS 6 days
Siu et al [8]	72	PSA 9 ng/mL	Gleason grade 6/10 prostate cancer	Not reported	Radiotherapy	Non applicable	In 2-year follow-up colonoscopy revealed no recurrence and PSA level was 0.7 ng/mL.
Siu et al [8]	73	Rectal tumor detected by DRE, PSA 7.9 ng/mL	Gleason grade 7/10 adenocarcinoma	3 cm T3 rectal cancer at dentate line	5-FU and radiotherapy	Non applicable	In 1-year follow-up no evidence of residual or recurrent rectal malignancy, PSA level 0.5 ng/mL.
Lin et al [9]	68	Rectal bleeding-rectal mass at DRE, PSA 57 ng/mL	T2N2M0 prostate adenocarcinoma (Gleason grade 5 (3 + 2))	3 cm T4N0M0 (Dukes’ stage C) rectal adenocarcinoma	LAR + radical retropubic prostatectomy + FOLFOX4, switched to FORFILI and then to capecitabine	Not reported	Death due to recurrence 47 months postoperatively
Lin et al [9]	65	Rectal bleeding-rectal mass at DRE, PSA 27 ng/mL	T3N0M0 prostate adenocarcinoma (Gleason grade 4 (2 + 2))	3 cm T4N1M0 (Dukes’ stage C) rectal adenocarcinoma	LAR + radical retropubic prostatectomy + FOLFOX4	Not reported	In 20-month follow-up asymptomatic
Lin et al [9]	70	Rectal bleeding-rectal mass at DRE, PSA 65 ng/mL	T3N1M0 prostate adenocarcinoma (Gleason grade 5 (2 + 3))	T3N0M0 (Dukes’ stage B) rectal adenocarcinoma	APR + radical retropubic prostatectomy + FOLFOX4	Not reported	In 24-month follow-up asymptomatic
Ayhan et al [10]	84	Hematemesis and rectal mass detected by DRE	T2N0M0 prostate adenocarcinoma	T3N1M1 rectal adenocarcinoma	APR	Pulmonary edema + respiratory infection	Died immediate post-operative period

Table 1. Presentation of Patients’ Demographics, Presenting Features, Histological Characteristics of the Prostate and Rectal Cancers, as Well as the Treatment Strategies Followed on Each Occasion and the Outcome of the Interventions

Authors

Age

Presenting feature(s)

Prostate cancer features

Rectal cancer features

Treatment

Postoperative complications

Outcome

Abbreviations: PSA: prostate specific antigen; DRE: digital rectal examination; APR: abdominoperineal resection; LAR: low anterior resection; LOS: length of stay.

Klee et al [7]

PSA 9.1 ng/mL

Gleason grade 7/10, stage T2C prostate adenocarcinoma right lateral wall

4 cm Duke’s stage B, moderately differentiated rectal adenocarcinoma

APR + radical rertropubic prostatectomy/blood loss 1,200 mL/operating time 4 h

Bowel obstruction and ischemic colostomy/LOS 16 days

At a minimum of 1 year of follow-up, all three patients had an undetectable PSA, and the rectal cancers remained in remission.

Klee et al [7]

PSA 5.9 ng/mL on routine rectal examination benign prostate, a left posterior lateral rectal wall mass

Gleason grade 6/10, stage T2A prostatic adenocarcinoma in right apex

2 cm Duke’s stage A, moderately differentiated rectal adenocarcinoma

APR + radical retropubic prostatectomy/blood loss 700 mL/operating time 3 h

Nil reported/LOS 8 days

Klee et al [7]

PSA 6.1 ng/mL, change of bowel habits, induration in left prostate base and PR bleeding in DRE

Gleason grade 7/10 adenocarcinoma in left side and in the right base

4.5 cm non-invasive villous adenoma without cancerous features

LAR + radical retropubic prostatectomy/blood loss 1,100 mL/operating time 2.25 h

Rectal and bladder neck stricture/LOS 6 days

Siu et al [8]

PSA 9 ng/mL

Gleason grade 6/10 prostate cancer

Not reported

Radiotherapy

Non applicable

In 2-year follow-up colonoscopy revealed no recurrence and PSA level was 0.7 ng/mL.

Siu et al [8]

Rectal tumor detected by DRE, PSA 7.9 ng/mL

Gleason grade 7/10 adenocarcinoma

3 cm T3 rectal cancer at dentate line

5-FU and radiotherapy

Non applicable

In 1-year follow-up no evidence of residual or recurrent rectal malignancy, PSA level 0.5 ng/mL.

Lin et al [9]

Rectal bleeding-rectal mass at DRE, PSA 57 ng/mL

T2N2M0 prostate adenocarcinoma (Gleason grade 5 (3 + 2))

3 cm T4N0M0 (Dukes’ stage C) rectal adenocarcinoma

LAR + radical retropubic prostatectomy + FOLFOX4, switched to FORFILI and then to capecitabine

Not reported

Death due to recurrence 47 months postoperatively

Lin et al [9]

Rectal bleeding-rectal mass at DRE, PSA 27 ng/mL

T3N0M0 prostate adenocarcinoma (Gleason grade 4 (2 + 2))

3 cm T4N1M0 (Dukes’ stage C) rectal adenocarcinoma

LAR + radical retropubic prostatectomy + FOLFOX4

Not reported

In 20-month follow-up asymptomatic

Lin et al [9]

Rectal bleeding-rectal mass at DRE, PSA 65 ng/mL

T3N1M0 prostate adenocarcinoma (Gleason grade 5 (2 + 3))

T3N0M0 (Dukes’ stage B) rectal adenocarcinoma

APR + radical retropubic prostatectomy + FOLFOX4

Not reported

In 24-month follow-up asymptomatic

Ayhan et al [10]

Hematemesis and rectal mass detected by DRE

T2N0M0 prostate adenocarcinoma

T3N1M1 rectal adenocarcinoma

APR

Pulmonary edema + respiratory infection

Died immediate post-operative period

**Table 2.** Presentation of Patients’ Demographics, Presenting Features, Histological Characteristics of the Prostate and Rectal Cancers, as Well as the Treatment Strategies Followed on Each Occasion and the Outcome of the Interventions
Authors	Age	Presenting feature(s)	Prostate cancer features	Rectal cancer features	Treatment	Postoperative complications	Outcome
Abbreviations: PSA: prostate specific antigen; DRE: digital rectal examination; APR: abdominoperineal resection; LAR: low anterior resection; LOS: length of stay.
Ozsoy et al [11]	68	PSA 10 ng/mL	cT3aN0M0/Gleason grade 8	pT3N0 rectal adenocarcinoma	Radiotherapy	Non-applicable	Dead due to liver metastases from rectal primary/no evidence of prostate cancer recurrence at 1.08 years follow-up
Kavanagh et al [12]	n = 9 patients (mean age: 67.8 ± 10.3 years)	Rectal bleeding (n = 5), partial obstruction (n = 1), tenesmus (n = 1) and incidental during imaging for prostate cancer (n = 2)/elevated PSA in seven cases (mean PSA values: 21.4 ± 15.2 ng/mL)	Not reported	In group with no distant metastases (n = 5): ypT3N0, ypT4N1, ypT3N0, ypT3N1 (not reported for n = 1)	In group with no distant metastases (n = 5): 1) Radiotherapy + APR + prostatectomy (n = 1) 2) Radiotherapy + pelvic exenteration + ileal conduit (n = 1) 3) Radiotherapy + pelvic exenteration + colonic conduit (n = 1) 4) Radiotherapy + watchful waiting (n = 1) 5) Prostatectomy + CRT + LAR (n = 1) In group with distant metastases (n = 4): 1) Hormonal therapy + chemotherapy 2) Hormonal therapy + anterior resection 3) Hormonal therapy + palliation 4) watchful waiting/spinal decompression and radiotherapy	Wound infection (n = 2), foot drop + intra-abdominal collection (n = 1)/LOS: 33 ± 25.4 days	In group with no distant metastases (n = 5): dead with no evidence of recurrence after 10 years (n = 1), dead due to metastases after 29 months (n = 1), alive at 7 months with no evidence of recurrence (n = 1), alive at 4 years with metastases, alive at 3 months with no evidence of recurrence (n = 1) In group with distant metastases (n = 4): mean survival 8.5 months (range: 1 - 14 months)
Terris et al [13]	68	Not reported regarding rectal cancer/PSA 8.2 ng/mL	Stage T1c, Gleason grade 3 + 3 prostate cancer	Not reported	Preoperative radiotherapy + APR	Not reported	Alive at 15 months follow-up with PSA 0.5 ng/mL/No data regarding rectal cancer
Terris et al [13]	72	Not reported regarding rectal cancer/PSA 7.9 ng/mL	Stage T2a, Gleason grade 3 + 4 prostate cancer	Not reported	Preoperative radiotherapy + APR	Not reported	Alive at 10 months follow-up with PSA < 0.5 ng/mL/No data regarding rectal cancer
Terris et al [13]	73	Not reported regarding rectal cancer/PSA 32.4 ng/mL	Stage T3, Gleason grade 4 + 4 prostate adenocarcinoma	Not reported	Androgen deprivation therapy + APR	Not reported	Alive at 10 months follow-up with PSA 9 ng/mL/No data regarding rectal cancer
Colonias et al [14]	58	Rectal bleeding-rectal mass at DRE, PSA 32 ng/mL	stage II (T1cN0M0) prostate adenocarcinoma	stage III (T3N1M0), moderately differentiated rectal adenocarcinoma	Neoadjuvant CRT with androgen blockage, followed by proctosigmoidectomy and adjuvant chemotherapy with 5-FU and leucovorin	Not reported	In 14-month follow-up asymptomatic with PSA 0.3 ng/mL

Table 2. Presentation of Patients’ Demographics, Presenting Features, Histological Characteristics of the Prostate and Rectal Cancers, as Well as the Treatment Strategies Followed on Each Occasion and the Outcome of the Interventions

Authors

Age

Presenting feature(s)

Prostate cancer features

Rectal cancer features

Treatment

Postoperative complications

Outcome

Abbreviations: PSA: prostate specific antigen; DRE: digital rectal examination; APR: abdominoperineal resection; LAR: low anterior resection; LOS: length of stay.

Ozsoy et al [11]

PSA 10 ng/mL

cT3aN0M0/Gleason grade 8

pT3N0 rectal adenocarcinoma

Radiotherapy

Non-applicable

Dead due to liver metastases from rectal primary/no evidence of prostate cancer recurrence at 1.08 years follow-up

Kavanagh et al [12]

n = 9 patients (mean age: 67.8 ± 10.3 years)

Rectal bleeding (n = 5), partial obstruction (n = 1), tenesmus (n = 1) and incidental during imaging for prostate cancer (n = 2)/elevated PSA in seven cases (mean PSA values: 21.4 ± 15.2 ng/mL)

Not reported

In group with no distant metastases (n = 5): ypT3N0, ypT4N1, ypT3N0, ypT3N1 (not reported for n = 1)

In group with no distant metastases (n = 5):
1) Radiotherapy + APR + prostatectomy (n = 1)
2) Radiotherapy + pelvic exenteration + ileal conduit (n = 1)
3) Radiotherapy + pelvic exenteration + colonic conduit (n = 1)
4) Radiotherapy + watchful waiting (n = 1)
5) Prostatectomy + CRT + LAR (n = 1)
In group with distant metastases (n = 4):
1) Hormonal therapy + chemotherapy
2) Hormonal therapy + anterior resection
3) Hormonal therapy + palliation
4) watchful waiting/spinal decompression and radiotherapy

Wound infection (n = 2), foot drop + intra-abdominal collection (n = 1)/LOS: 33 ± 25.4 days

In group with no distant metastases (n = 5): dead with no evidence of recurrence after 10 years (n = 1), dead due to metastases after 29 months (n = 1), alive at 7 months with no evidence of recurrence (n = 1), alive at 4 years with metastases, alive at 3 months with no evidence of recurrence (n = 1)
In group with distant metastases (n = 4): mean survival 8.5 months (range: 1 - 14 months)

Terris et al [13]

Not reported regarding rectal cancer/PSA 8.2 ng/mL

Stage T1c, Gleason grade 3 + 3 prostate cancer

Not reported

Preoperative radiotherapy + APR

Not reported

Alive at 15 months follow-up with PSA 0.5 ng/mL/No data regarding rectal cancer

Terris et al [13]

Not reported regarding rectal cancer/PSA 7.9 ng/mL

Stage T2a, Gleason grade 3 + 4 prostate cancer

Not reported

Preoperative radiotherapy + APR

Not reported

Alive at 10 months follow-up with PSA < 0.5 ng/mL/No data regarding rectal cancer

Terris et al [13]

Not reported regarding rectal cancer/PSA 32.4 ng/mL

Stage T3, Gleason grade 4 + 4 prostate adenocarcinoma

Not reported

Androgen deprivation therapy + APR

Not reported

Alive at 10 months follow-up with PSA 9 ng/mL/No data regarding rectal cancer

Colonias et al [14]

Rectal bleeding-rectal mass at DRE, PSA 32 ng/mL

stage II (T1cN0M0) prostate adenocarcinoma

stage III (T3N1M0), moderately differentiated rectal adenocarcinoma

Neoadjuvant CRT with androgen blockage, followed by proctosigmoidectomy and adjuvant chemotherapy with 5-FU and leucovorin

Not reported

In 14-month follow-up asymptomatic with PSA 0.3 ng/mL