Proton therapy in the simultaneous treatment of recurrence of a prostate tumor and preoperative radiation of a rectal tumor

Abstract

Malignant neoplasms of the pelvic organs in men occupy leading positions in the structure of oncological morbidity. We present a clinical case of patient A., 84 years old, who had been under dispensary observation since 2008 after being diagnosed with prostate adenocarcinoma T2cN0M0 (Gleason 4+4). In 2009, the patient underwent maximal androgen blockade and radical prostatectomy. In August 2023, he presented with complaints of rectal pain and bleeding; diagnostic evaluation revealed an increase in PSA level up to 7.6 ng/ml, a tumor of the middle-upper ampullary rectum with mesorectal lymph node involvement, as well as a local recurrence in the prostate bed. Histological examination confirmed adenocarcinoma (Gleason 4+4) in the prostate bed and adenocarcinoma G2 of the rectum. The patient underwent proton radiotherapy to the rectal tumor, the zone of subclinical spread, and the prostate bed. This case highlights the necessity of a multidisciplinary approach in determining treatment strategies for colorectal cancer, especially in the presence of multiple adjacent tumors. The presented case demonstrates successful treatment of a patient with primary multiple metachronous cancer: recurrence of prostate cancer 14 years after surgery and a synchronous rectal tumor.