Outcomes of Surgical Treatment of Multiple Primary Colorectal and Prostate Cancer

Aim: to evaluate the outcomes of surgical treatment of patients with multiple primary cancer of the colon and prostate.
Materials and methods. An observational retrospective study was conducted at the Clinic of Coloproctology and Minimally Invasive Surgery (I.M. Sechenov First Moscow State Medical University). A total of 3,640 protocols of the preoperative multidisciplinary team were studied from July 2018 to April 2024. The inclusion criterion was the diagnosis of multiple colorectal and prostate cancer. The medical documentation was collected in the database and analyzed.
Results. The study included 39 patients: 24 patients with a metachronous variant of multiple primary cancer and 15 patients with a synchronous variant of the disease, which amounted to 1.1 % of all patients who underwent a preoperative consultation during the specified period. There were no significant differences in age, localization of tumors in the colon, methods of their treatment, access in surgical treatment of colorectal cancer, frequency of conversions and postoperative complications (p > 0.05). Prostate cancer was verified first in the group with the metachronous variant of multiple primary cancer significantly more often than in the group with the synchronous variant (95.8 % vs. 40.0 %, respectively; p < 0.001), and was also significantly more often treated surgically (75.0 % vs. 33.3 %; p = 0.018). Radical prostatectomy was performed via laparotomy significantly less frequently in the group with the synchronous variant than in the group with the metachronous cancer (0 % vs. 58.8 %; p = 0.046). No significant differences were found when comparing overall and recurrence-free survival in groups with metachronous and synchronous variants of multiple primary cancer.
Conclusions. A clinician should be alert to multiple primary colorectal and prostate cancer. The first stage of therapy for the synchronous variant should be surgical treatment of colorectal cancer. The history of surgical treatment of one of the tumors is not a contraindication for the use of minimally invasive techniques, however, the choice of surgical approach should be individualized. The presence of prostate cancer may be another factor in favor of performing lateral lymph node dissection in patients with synchronous rectal cancer.

1. Bray F., Laversanne M., Sung H., Ferlay J., Siegel R.L., Soerjomataram I., et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. DOI: 10.3322/caac.21834

2. Sidiqi B.U., Nosrati J.D., Wu V., Kobritz M., La Gamma N., Whelan R.L., et al. The prevalence and management of synchronous prostate and rectal cancer. Int J Radiat Oncol Biol Phys. 2023;117(2):e339. DOI: 10.1016/j.ijrobp.2023.06.2398

3. Nosov D.A., Volkova M.I., Gladkov O.A., Karabina E.V., Krylov V.V., Matveev V.B., et al. Practical recommendations for drug treatment of prostate cancer. Practical recommendations of RUSSCO, part 1. Malignant tumours. 2023;13(3s2):640–60. (In Russ.). DOI: 10.18027/2224-5057-2023-13-3s2-1-640-660

4. Schaeffer E.M., Srinivas S., Adra N., An Y., Barocas D., Bitting R., et al. Prostate cancer, version 4.2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2023;21(10):1067–96. DOI: 10.6004/jnccn.2023.0050

5. Celentano G., Creta M., Napolitano L., Abate M., La Rocca R., Capece M., et al. Prostate cancer diagnosis, treatment and outcomes in patients with previous or synchronous colorectal cancer: A systematic review of published evidence. Diagnostics (Basel). 2022;12(6):1475. DOI: 10.3390/diagnostics12061475

6. Lavan N.A., Kavanagh D.O., Martin J., Small C., Joyce M.R., Faul C.M., et al. The curative management of synchronous rectal and prostate cancer. Br J Radiol. 2016;89(1057):20150292. DOI: 10.1259/bjr.20150292

7. Yaegashi M., Otsuka K., Nakamura Y., Hatanaka T., Takashimizu K., Sasaki A. Advanced synchronous rectal and prostate cancers diagnosed by lateral lymph node dissection: A case report. Int J Surg Case Rep. 2021;88:106494. DOI: 10.1016/j.ijscr.2021.106494

8. Stepanova Yu.A., Kalinin D.V., Vishnevsky V.A. Multiple primary neoplasms (literature review). Medical Visualization. 2015;6:93–102. (In Russ.).

9. Kavanagh D.O., Quinlan D.M., Armstrong J.G., Hyland J.M., O’Connell P.R., Winter D.C. Management of synchronous rectal and prostate cancer. Int J Colorectal Dis. 2012;27(11):1501–8. DOI: 10.1007/s00384-012-1465-z

10. Sharp H.J., Swanson D.A., Pugh T.J., Zhang M., Phan J., Kudchadker R., et al. Screening colonoscopy before prostate cancer treatment can detect colorectal cancers in asymptomatic patients and reduce the rate of complications after brachytherapy. Pract Radiat Oncol. 2012;2(3):e7–13. DOI: 10.1016/j.prro.2011.11.010

11. Jacobs C.D., Trotter J., Palta M., Moravan M.J., Wu Y., Willett C.G., et al. Multi-institutional analysis of synchronous prostate and rectosigmoid cancers. Front Oncol. 2020;10:345. DOI: 10.3389/fonc.2020.00345

12. Sturludóttir M., Martling A., Carlsson S., Blomqvist L. Synchronous rectal and prostate cancer — the impact of MRI on incidence and imaging findings. Eur J Radiol. 2015;84(4):563–7. DOI: 10.1016/j.ejrad.2014.12.030

13. Terris M.K., Wren S.M. Results of a screening program for prostate cancer in patients scheduled for abdominoperineal resection for colorectal pathologic findings. Urology. 2001;57(5):943–5. DOI: 10.1016/s0090-4295(01)00943-8

14. Lakkis Z., Vernerey D., Mege D., Faucheron J.L., Panis Y., Tuech J.J., et al. Morbidity and oncological outcomes of rectal cancer impaired by previous prostate malignancy. Br J Surg. 2019;106(8):1087–98. DOI: 10.1002/bjs.11176

15. Tomminen T., Huhtala H., Kotaluoto S., Veitonmäki T., Wirta E.V., Hyöty M. Surgical and oncological results after rectal resections with or without previous treatment for prostate cancer. Front Surg. 2024;11:1298865. DOI: 10.3389/fsurg.2024.1298865

16. Liu Z., Li D., Chen Y. Endoscopic extraperitoneal radical prostatectomy after radical resection of pT1-pT2 rectal cancer: A report of thirty cases. Wideochir Inne Tech Maloinwazyjne. 2017;12(1):68–74. DOI: 10.5114/wiitm.2017.66475

17. Luciani L.G., Mattevi D., Puglisi M., Processali T., Anceschi U., Lauro E., et al. Robotic-assisted radical prostatectomy following colorectal surgery: A user’s guide. J Robot Surg. 2022;16(1):189–92. DOI: 10.1007/s11701-021-01228-1

18. Klee L.W., Grmoljez P. Combined radical retropubic prostatectomy and rectal resection. Urology. 1999;54(4):679–81. DOI: 10.1016/s0090-4295(99)00201-0

19. Lin C., Jin K., Hua H., Lin J., Zheng S., Teng L. Synchronous primary carcinomas of the rectum and prostate: Report of three cases. Oncol Lett. 2011;2(5):817–9. DOI: 10.3892/ol.2011.323

20. Gys B., Fransis K., Hubens G., Van den Broeck S., Op de Beeck B., Komen N. Simultaneous laparoscopic proctocolectomy (TaTME) and robot-assisted radical prostatectomy for synchronous rectal and prostate cancer. Acta Chir Belg. 2019;119(1):47–51. DOI: 10.1080/00015458.2017.1411550

21. Bezrukov E.A., Rapoport L.M., Morozov A.O., Martirosyan G.A., Strizhova M.A. Evolution of the technique of implementation and role of radical prostatectomy. Siberian Medical Review. 2017;3(105):61–7. (In Russ.). DOI: 10.20333/2500136-2017-3-61-67

22. Tsarkov P.V., Babajanyan A.R., Tulina I.A., Khusainov A.R., Sidorova L.V., Lukyanov A.M. Risk factors for lateral pelvic lymph nodes damaging. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(1):57–61. (In Russ.). DOI: 10.25881/BPNMSC.2021.97.93.010

23. Ishikawa T., Homma S., Nishikawa M., Nakamoto H., Yokoyama R., Taketomi A. Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases. Asian J Endosc Surg. 2019;12(1):118–21. DOI: 10.1111/ases.12598

24. Sugihara K., Kobayashi H., Kato T., Mori T., Mochizuki H., Kameoka S., et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49(11):1663–72. DOI: 10.1007/s10350-006-0714-z

25. Joniau S., Van den Bergh L., Lerut E., Deroose C.M., Haustermans K., Oyen R., et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013;63(3):450–8. DOI: 10.1016/j.eururo.2012.06.057

26. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma: The 3d English edition [secondary publication]. J Anus Rectum Colon. 2019;3(4):175–95. DOI: 10.23922/jarc.2019-018

27. Porpiglia F., De Luca S., Bertolo R., Passera R., Mele F., Manfredi M., et al. Robot-assisted extended pelvic lymph nodes dissection for prostate cancer: Personal surgical technique and outcomes. Int Braz J Urol. 2015;41(6):1209–19. DOI: 10.1590/S1677-5538.IBJU.2015.0055