Prostate cancer and colorectal malignancies are the most common cancers in men, contributing to 15% and 9% of new cancer cases, respectively [1]. Furthermore, it is not uncommon to encounter patients with synchronous or metachronous colorectal and prostate cancers [2-3]. Ab-dominoperineal resection (APR) is often performed for surgical treatment of rectal cancer in addition to treatment of ulcerative colitis and familial polyposis coli. The technical aspects of an APR include a combined perineal and abdominal approach to resecting the rectum and mes-orectum, in addition to the anus, perineal soft tissue and pelvic floor musculature [4].

The screening and treatment of patients with prostate cancer after an APR is challenging and unique. Enblad et al. [5] found a relative risk of 2.2 for the diagnosis of a second primary neoplasm in the prostate within 1 year after the diagnosis of rectal malignancy. After APR for colorectal pathologic features, however, there is no rectum for access to the prostate. This precludes the use of digital rectal examination (DRE) or transrectal ultrasound (TRUS)-guided prostate biopsies to diagnose primary tumors of the prostate [6-10].

Several methods have been described to evaluate the prostate in the patient with elevated prostate-specific antigen (PSA) levels who have undergone APR, including transperineal ultrasound (TPUS)-guided biopsy, transurethral ultrasounded guided perineal biopsy and computed tomography (CT)/magnetic resonance imaging (MRI) guided techniques. The aim of this chapter is to review the screening for prostate cancer in patients preparing for an APR and discuss post-APR screening and prostate biopsy techniques, limitations and practical considerations.

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