Concomitant prostate cancer screening in the patient preparing for an APR

Patients scheduled to undergo APR represent a patient population in which prostate cancer screening may be indicated. Most cases of rectal cancer are diagnosed after 50 years of age [17], and are in the same age category of men at risk for prostate cancer diagnosis. However, the stage of rectal cancer should be taken into consideration when considering screening the same individual for prostate cancer: Stage T1 and T2 rectal tumors treated with APR have a ~90% 5-year survival, while stage T3 and T4 tumors are generally treated with neoadjuvant chemotherapy and/or radiation and generally have a 5-year survival of 50% and 25%, respectively [17]. Thus, prostate cancer screening in patients with advanced disease should be avoided.

Terris and Wren previously described a prostate cancer-screening program for 19 consecutive men scheduled for APR for colorectal carcinoma with no history of prostate cancer [18]. Screening included serum PSA and DRE and those with suspicious findings underwent TRUS-guided sextant biopsy. Six patients (31%) had a PSA >4.0 ng/mL (range 4.4 to 32.4 ng/mL, mean 9.3 ng/mL) of which two patients also had an abnormal DRE. TRUS-guided biopsy revealed prostate cancer in three individuals (50%). These patients included an individual with clinical stage T1c, Gleason 3+3=6 adenocarcinoma of the prostate treated with radiation, a second patient with clinical stage T2a, Gleason 3+4=7 adenocarcinoma of the prostate treated with radiation, and a third individual with a PSA of 32.4 ng/mL and DRE

consistent with extracapsular extension of prostate cancer (clinical stage T3, Gleason 4+4=8 adenocarcinoma of the prostate) managed with androgen deprivation therapy. Concomitant prostate cancer screening for patients planning an APR should be a multi-disciplinary decision between the General Surgeons and Urologist in the male patient older than 50 years of age with clinical stage T1 or T2 rectal cancer and a life expectancy of more than 10 years.

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