Rectosigmoid cancer after radiotherapy for prostate cancer can be detected early and successfully treated.

The clinical features and outcomes of rectosigmoid cancers (RSCs) occurring after radiotherapy (RT) for prostate cancer were reviewed to determine whether they are significantly different to RSC occurring without those precedents, whether the subsequent RSC could be either predicted or detected early, and whether they can be effectively treated. Eight patients who had been treated by RT for prostate cancer subsequently developed lower gastrointestinal tract symptoms consistent with proctopathy, however, investigation by endoscopy indicated RSC. These cases were reviewed in detail. The most common presenting symptom was mild bleeding. All eight RSCs were detected before the development of metastatic disease and successfully treated. Only one required an anteroposterior resection. Otherwise, there were no unusual features about any of the cases that would have predicted the occurrence of RSC or enabled earlier detection. No complications occurred that could be attributed to prior RT. Six recommendations for clinicians are offered on the basis of these cases and the relevant published work. In particular, when symptoms of proctopathy occur after RT for prostate cancer the conclusion that radiation proctopathy is the cause should not be drawn until confirmed by endoscopy. Prior RT did not increase the risks involved in colorectal surgery in this setting.