Rectal Wall Recurrence of Prostatic Adenocarcinoma

Abstract

Case 1. A 60-year-old man was treated with 72 Gy. external beam radiation therapy for Gleason score 4 3 adenocarcinoma of the prostate diagnosed by transrectal ultrasound guided biopsy. After treatment prostate specific antigen (PSA) decreased to 1.3 ng./ml. One year later PSA had increased to 2.0 ng./ml. Transrectal ultrasound guided biopsy revealed recurrent prostatic adenocarcinoma. Salvage cryosurgical ablation of the prostate was then performed, after which PSA decreased to less than 0.5 ng./ml. Three years after primary therapy, repeat transrectal ultrasound was performed for a superficial palpable nodule noted on digital rectal examination. At that time PSA was 1.8 ng./ml. Transrectal ultrasound demonstrated a fusiform mass in the rectal wall. Biopsy of the mass showed Gleason score 4 4 adenocarcinoma. The patient subsequently received hormone ablation therapy. Six years after initial treatment he is living with hormone refractory prostate cancer. Case 2. A 74-year-old man underwent cryosurgical ablation of the prostate for Gleason score 2 3 adenocarcinoma, which was detected by transrectal ultrasound guided biopsy. Sixteen months after cryotherapy PSA had increased to 6.0 ng./ml. and transrectal ultrasound guided biopsy revealed Gleason score 3 4 adenocarcinoma. Salvage cryosurgical ablation of the prostate was then performed, after which PSA decreased to less than 0.1 ng./ml. Forty-two months after the second cryoablation transrectal ultrasound was performed for increasing PSA and a palpable mass on digital rectal examination. The scan demonstrated a fusiform hypoechoic lesion within the muscularis propria of the rectum (see figure). Biopsies of the mass showed Gleason score 3 4 adenocarcinoma. The patient was subsequently treated with external beam radiation therapy, and PSA was undetectable 27 months after treatment.