Center for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Int J Colorectal Dis. 2012 Nov;27(11):1501-8. doi: 10.1007/s00384-012-1465-z. Epub 2012 Mar 28.
Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution's experience with this and propose a treatment algorithm based on the best available evidence.
From 2000 to 2011, a retrospective review of institutional databases was performed to identify patients with synchronous prostate and rectal cancers where the rectal cancer lay in the lower two thirds of the rectum. Operative and non-operative outcomes were analysed and a management algorithm is proposed.
Twelve patients with prostate and rectal cancer were identified. Three were metachronous diagnoses (>3-month time interval) and nine were synchronous diagnoses. In the synchronous group, four had metastatic disease at presentation and were treated symptomatically, while five were treated with curative intent. Treatment included pelvic radiotherapy (74 Gy) followed by pelvic exenteration (three) and watchful waiting for rectal cancer (one). The remaining patient had a prostatectomy, long-course chemoradiotherapy and anterior resection. There were no operative mortalities and acceptable morbidity. Three remain alive with two patients disease-free.
Synchronous detection of prostate cancer and cancer of the lower two thirds of the rectum is uncommon, but likely to increase with rigorous preoperative staging of rectal cancer and increased awareness of the potential for synchronous disease. Treatment must be individualized based on the stage of the individual cancers taking into account the options for both cancers including EBRT (both), surgery (both), hormonal therapy (prostate), surgery (both) and watchful waiting (both).
尽管已有相关描述，但目前有关前列腺癌和直肠癌并存的管理方面的数据有限。本研究旨在描述一家机构在此方面的经验，并根据现有最佳证据提出治疗方案。
对 2000 年至 2011 年的机构数据库进行回顾性分析，以确定同时患有前列腺癌和直肠癌且直肠癌位于直肠下 2/3 段的患者。分析手术和非手术治疗的结果，并提出一种治疗方案。
共确定了 12 例前列腺癌和直肠癌患者。其中 3 例为异时性诊断（>3 个月的时间间隔），9 例为同时性诊断。在同时性组中，4 例患者在就诊时已有转移病灶，给予对症治疗，5 例患者给予根治性治疗。治疗包括盆腔放疗（74Gy），随后行盆腔廓清术（3 例）和直肠观察等待（1 例）。其余患者行前列腺切除术、长程放化疗和前切除术。无手术死亡，并发症发生率可接受。3 例患者仍存活，其中 2 例无疾病。
前列腺癌和直肠下 2/3 段癌同时发现的情况并不常见，但随着直肠癌术前分期的严格化和对同时性疾病的认识提高，这种情况可能会增加。治疗必须根据个体癌症的分期个体化，考虑到两种癌症的治疗选择，包括外照射治疗（两者）、手术（两者）、激素治疗（前列腺）、手术（两者）和观察等待（两者）。
