Rectal infiltration by prostatic adenocarcinoma: report on six patients and review of the literature

Aims: To describe the outcome of six patients with rectal infiltration by prostatic adenocarcinoma and review the literature for 1966-2002. Patients and Methods: Six patients were identified from prospectively maintained records of a colorectal surgeon and the case records reviewed retrospectively. Information on these patients was collated with that on patients reported in the literature. The Medline database was searched from the years 1966-2002 using the keywords: adenocarcinoma, carcinoma, colon, metastasis, prostate, rectum. Results and Conclusions: Autopsy studies have indicated that rectal involvement by prostatic adenocarcinoma occurs in 4% of patients (range, 1-12%). The rectal infiltration took the form of an anterior rectal mass with or without ulceration in 52%, an annular stricture in 45%, and separate metastasis in 3%. In 40% of patients, a preceding history of prostatic adenocarcinoma was elicited at the time of gastrointestinal presentation, while in 60% it was not elicited. In the study group, 26% of patients underwent surgery; the most commonly performed procedure was a defunctioning colostomy (18%) to alleviate symptoms of large bowel obstruction. Five patients underwent rectal resection because the pre-operative diagnosis was suspected to be primary rectal adenocarcinoma. The median survival was 15 months (95% confidence interval 14-16 months). Survival beyond 30 months was rare.