Multi-institutional analysis of synchronous prostate and rectosigmoid cancers.

Abstract

33 Background: Synchronous prostate cancer (PC) and rectosigmoid (RS) cancer (RSC) is a challenging clinical situation. Methods: A retrospective review of Duke University and Durham VA charts was performed for men with adenocarcinomas of the prostate and RS colon from 1988-2017. Synchronous presentation was defined as symptoms, diagnosis (dx), or treatment (tx) of PC/RSC within 12 months. The primary endpoint was overall survival (OS), calculated from latest dx date. Univariate and multivariate (MVA) Cox regression was performed using STATA 15.1. Results: Among 31,883 men with PC identified, 330 (1%) also had RSC. 54 (16%) were considered synchronous (median age 67, IQR 62-72). PC was more commonly the first dx (59%), and 15 (28%) underwent prostatectomy (n=13) or radiotherapy (RT, n=2) before a dx of synchronous RSC. 26%, 57%, and 17% had stage I, II-III, and IV RSC, respectively. Prostatectomy, LAR, APR, and combined surgery for both PC/RSC was performed in 17 (31%), 24 (44%), 10 (19%), and 2 (4%) men, respectively. 35 (65%) received RT with median RS dose of 50.4 Gy (IQR 50.4-54 Gy) and prostate boost to 66 Gy (IQR 61-72 Gy). 34 (63%) received 5-FU based chemotherapy, 23 (43%) received ADT, and 9 (17%) received no PC-specific tx. After a median follow up of 43 (IQR 21-93) months, there were 34 deaths: 18 (53%) due to RSC, 2 (6%) due to PC, 3 (9%) due to grade 5 toxicity, 7 (21%) due to another malignancy, and 4 (12%) due to unknown cause without recurrence. Grade 5 toxicities resulted from sequential hepatectomy/LAR, combined prostatectomy/APR, and myocardial infarction while on ADT. Crude late grade ≥3 toxicities include 9 (17%) GI and 6 (11%) GU. Two anastomotic leaks <2.3 years after LAR occurred in men who received neoadjuvant prostate RT boost of 70.6-76.4 Gy. Stages II-III (HR 4.3, p=0.02) and IV (HR 16, p<0.01) for RSC but only stage IV (HR 31, p<0.01) for PC were significantly associated with OS on MVA. Among 30 men with stage II-III RSC and non-metastatic PC, 5-FU based chemotherapy (HR 0.34, p=0.04) but no PC-specific tx was significantly associated with OS on MVA. Conclusions: Synchronous RSC is a greater contributor to mortality than PC. Men aged ≥50 with localized PC should undergo colorectal cancer screening prior to tx to evaluate for synchronous RSC.

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

“…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).…”

“…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).…”

“…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).…”

“…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.…”