Synchronous prostate and rectal cancers across a large distributed healthcare system: Implications for national accreditation program for rectal cancer (NAPRC) guidelines.
Authors: Wu Vernon , Sidiqi Baho , Kobritz Molly , Purchla Julia , Herman Joseph M. , La Gamma Nicholas A. , Whelan Richard L. , King Daniel 
Published: June 2022

e15591 Background: Prostate and colorectal cancers are among the most common cancers in men. The prevalence of patients (pts) diagnosed with prostate and rectal cancers at the same time (synchronous) is unknown and guidelines for co-management are not well established despite implications on their co-management. This study aggregated data using several methods across New York’s largest healthcare system, studied the prevalence of synchronous diagnoses, and identified a potential need for prostate specific antigen (PSA) assessment in NAPRC guidelines. Methods: We conducted an IRB approved review of pts using 3 different cohorts from 2010-2021: Northwell Health NAPRC tumor boards, the Oncora radiation oncology database, and the Northwell Health clinical informatics tool Population Analyzer to access electronic health records across the entire Northwell Health System. Synchronous diagnosis was defined as prostate cancer diagnosed during the workup of rectal cancer. Results: Ten pts had synchronous prostate and rectal cancers. Workup of prostate cancer was prompted by elevated PSA alone (n = 3), prostate lesion on rectal cancer staging MRI alone (n = 3), or both (n = 4). Two pts declined recommended treatment (tx). Radiation (RT) volume for pts during neoadjuvant RT included the rectum and prostate. Patients received total neoadjuvant therapy (n = 6) or neoadjuvant chemoRT (n = 4) alone. Three pts had surgery for rectal cancer after neoadjuvant tx. Eight patients received androgen deprivation therapy (n = 8); after neoadjuvant tx pts also had prostate-specific RT (n = 6) or prostate brachytherapy (n = 2). Six pts completed neoadjuvant tx; after a median follow up of 25.9 months 4 pts have no evidence of prostate or rectal cancers. One pt has residual disease with plan for surgical resection; one pt developed new metastases. Median overall survival was 114 months with one death. Among 273 newly diagnosed rectal cancer pts presented at NAPRC tumor boards, there were 122 male pts age ≥ 40 years of which 70% (n = 81) did not have PSA screen at rectal cancer diagnosis. Medical oncologists ordered PSA in 72% (n = 13) of pts not evaluated by primary care. Conclusions: We aggregated data via several methods and performed system wide evaluation of electronic health records across New York State’s largest healthcare system. PSA was not evaluated in a majority of eligible pts. These results support PSA testing in NAPRC guidelines for new rectal cancer diagnosis as it is inexpensive, non-invasive, and may prompt prostate cancer workup. Additionally, 3 pts with prostate cancer did not have prostate lesions on rectal MRI imaging, suggesting a potential role for prostate-protocoled imaging during radiological workup of rectal cancer. Future studies are needed to develop best management of synchronous prostate and rectal cancers due to a lack of consensus guidelines.