Abstract
Purpose: To perform a multi-institutional analysis of patients with synchronous prostate and rectosigmoid cancers.Materials and Methods: A retrospective review of Duke University and Durham Veterans Affairs Medical Center records was performed for men with both prostate and rectosigmoid adenocarcinomas from 1988 to 2017. Synchronous presentation was defined as symptoms, diagnosis, or treatment of both cancers within 12 months of each other. The primary study endpoint was overall survival. Univariate and multivariable Cox regression was performed.Results: Among 31,883 men with prostate cancer, 330 (1%) also had rectosigmoid cancer and 54 (16%) of these were synchronous. Prostate cancer was more commonly the initial diagnosis (59%). Fifteen (28%) underwent prostatectomy or radiotherapy before an established diagnosis of rectosigmoid cancer. Stage I, II–III, or IV rectosigmoid cancer was present in 26, 57, and 17% of men, respectively. At a median follow-up of 43 months, there were 18 deaths due rectosigmoid cancer and two deaths due to prostate cancer. Crude late grade ≥3 toxicities include nine (17%) gastrointestinal and six (11%) genitourinary. Two anastomotic leaks following low anterior resection occurred in men who received a neoadjuvant radiotherapy prostate dose of 70.6–76.4 Gy. Rectosigmoid cancer stages II–III (HR 4.3, p = 0.02) and IV (HR 16, p < 0.01) as well as stage IV prostate cancer (HR 31, p < 0.01) were associated with overall survival on multivariable analysis.Conclusions: Synchronous rectosigmoid cancer is a greater contributor to mortality than prostate cancer. Men aged ≥45 with localized prostate cancer should undergo colorectal cancer screening prior to treatment to evaluate for synchronous rectosigmoid cancer.
Highlights
Colorectal cancer (CRC) and prostate cancer (PC) are among the most common malignancies worldwide, representing two of the top three most frequently diagnosed malignancies for men [1] Because of their high frequency, it is not uncommon for men to be diagnosed with both malignancies during their lifetime [2]
Synchronous presentation was defined as objective documentation of clinical symptoms, laboratory data [e.g., elevated prostate specific antigen (PSA) or fecal occult blood positive], pathologic diagnosis, and/or primary treatment of one malignancy occurring within 12 months of the other
There were 7, 16, and 31 men diagnosed with synchronous PC/rectosigmoid cancer (RSC) between 1988–1997, 1998–2007, and 2008–2017, respectively
Summary
Colorectal cancer (CRC) and prostate cancer (PC) are among the most common malignancies worldwide, representing two of the top three most frequently diagnosed malignancies for men [1] Because of their high frequency, it is not uncommon for men to be diagnosed with both malignancies during their lifetime [2]. In men with newly diagnosed PC, screening colonoscopies identified synchronous CRC in >3% of men in one study [4] Synchronous presentation of both malignancies is less common than metachronous presentation; synchronous rates are increasing. Reasons for this increase are multifactorial, including increased screening for both malignancies, improved life expectancy, increased use of pelvic magnetic resonance imaging, and increased awareness [5,6,7]. Along these lines, the American Cancer Society recently updated CRC screening guidelines for individuals at average risk to initiate regular screening at age 45 [8]
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