Multi-Institutional Analysis of Synchronous Prostate and Rectosigmoid Cancers

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.

Multiple Primary Tumors Originating From the Prostate and Colorectum A Clinical-Pathological and Therapeutic Challenge

“…The incidence of D/MPMTs with prostate and colorectal origin varies considerably depending on the inclusion criteria, the size and characteristics of the cohort, the involved anatomical region of the large bowel, and the length of the follow-up ( Table 3 ) ( Jacobs et al, 2020 ; Kavanagh et al, 2012 ; L. Liu et al, 2011 ; Sturludóttir et al, 2015 ). Compared with Sturludóttir et al, who analyzed the association between PC and rectal cancer over a period of 16 years, Jacobs et al reported a twofold higher incidence for synchronous PC and rectosigmoid cancer over a period of 20 years ( Jacobs et al, 2020 ; Sturludóttir et al, 2015 ).…”

“…The incidence of D/MPMTs with prostate and colorectal origin varies considerably depending on the inclusion criteria, the size and characteristics of the cohort, the involved anatomical region of the large bowel, and the length of the follow-up ( Table 3 ) ( Jacobs et al, 2020 ; Kavanagh et al, 2012 ; L. Liu et al, 2011 ; Sturludóttir et al, 2015 ). Compared with Sturludóttir et al, who analyzed the association between PC and rectal cancer over a period of 16 years, Jacobs et al reported a twofold higher incidence for synchronous PC and rectosigmoid cancer over a period of 20 years ( Jacobs et al, 2020 ; Sturludóttir et al, 2015 ). Another study from Czech Republic showed that 2.3% of patients diagnosed with CRC between 2003 and 2013 and followed until 2018 developed PC ( Halamkova et al, 2021 ), in line with a Swedish study that has shown that 1.9% of those over 72,000 patients have associated colon cancer and PC ( Van Hemelrijck et al, 2012 ).…”

“…First described by Billroth in 1889 ( Billroth, 1889 ) and then defined by Warren and Gates ( Warren, 1932 ), D/MPMTs can be divided into two categories: (a) synchronous, meaning the cancers occur simultaneously (within 2 months according to the SEER definition) ( SEER, 1998 ); and (b) metachronous, with the cancers following a subsequent path (more than 2 months apart). Another classification system suggest a time frame of 6 months ( Das, 2017 ; Lv et al, 2017 ) or even 12 months ( Jacobs et al, 2020 ) to separate the two tumor categories. We chose the 6-month time frame to differentiate the synchronous tumors from the metachronous ones and the 3-year period to separate the early metachronous from the late ones.…”

“…In our case series, we identified a significantly higher metachronous tumor percentage than the synchronous one (85.7% vs. 14.3%), with an initial PC diagnosis in 72.2% of the cases, in accordance with other literature data that reported that the ratio of synchronous to metachronous tumors is definitely in favor of the metachronous ones, regardless of the location of the tumors ( Tziris et al, 2008 ). If it is to be referred strictly to metachronous prostate and colorectal tumors, Jacobs et al (2020) noticed that most cases of D/MPMTs (84%) with one of the tumors being PC and the second one being rectosigmoid cancer were metachronous tumors, with the PC tumor being the first one detected more frequently (59% of the cases) ( Jacobs et al, 2020 ).…”

“…A Dutch study that included almost 430,000 patients diagnosed with at least one form of cancer reported a prevalence of 7% for multiple malignancies, and 0.3% for the association of PC with CRC ( L. Liu et al, 2011 ). If we take into account only the association of PC with rectal cancer, the incidence varied between 0.4% and 0.5 % ( Kavanagh et al, 2012 ; Sturludóttir et al, 2015 ), increasing to 1% for PC and rectosigmoid cancer ( Jacobs et al, 2020 ). These cases represent a challenge for the physicians who manage them.…”