1. Ademola Popoola,BUHARI TAJUDEEN,Fidelis Ushie,Hamid Olanipekun. Department of Surgery University of Ilorin Teaching Hospital,Ilorin. Multiple Primary Cancers -simultaneously occurring prostate cancer and other primary tumors: any link or coincidences?

2. Introduction  Prostate cancer is the most commonly diagnosed malignancy affecting men beyond middle age.  Is the most common non cutaneous malignancy in the Western world.  2 nd leading cause of cancer death in men.  It is a major public health burden in Sub Sahara Africa.  In practice, prostate cancer has been reported to occur simultaneously (synchronous) or successively (metachronous).

3.  Some multiple cancer syndromes have been well defined. These include Von Hippel Lindau Syndrome (cerebellar & retinal heamangioma, renal, pancreatic and spinal meningeal tumors). Introduction [Cont’d]

4.  To report Multiple Primary Cancers (MPC) involving Prostate cancer in our centre in the last two years.  To identify from the literature possible associations of simultaneously occurring cancers. Aim

5.  Retrospective analyses from our database of patients with MPC involving prostate cancer in the last two years.  Review of existing literature for possible association. Methodology

6. AgePSA/ GLEASON’S Score Duration Btw 1 sT & 2 ND Tumour Second Tumour TreatmentOutcome 75yrs121ng/ml 3+2 =5 SynchronousUrinary Bladder ChemotherapyDeath due to urosepsis (5months) 72yrs>50ng/ml 5+4 =9 Metachronous (2yrs) ColonLHRH, BTO, Permanent colostomy Died of complications of intestinal obstruction 84yrs116.7ng/ml 4+3=7 Metachronous (12months) ColonBTOStill being managed until strike 60yrs110ng/ml 3+2 =5 SynchronousRectumBTOImproved Parasthesia & urinary symptoms 72yrs45ng/ml 3+2=5 Metachronous (24months) ThyroidBTO, Chemotherapy, Thyroidectomy Death due to progression of Prostate cancer 70yrs60ng/ml 4+3=7 SynchronousliverSupportive careDeath due to hepatic failure Discussion

7.  Prostate cancer could occur with other primary tumours as synchronous or metachronous.  This has been adduced to increased life span and improved diagnostic tools.  There are existing literatures reporting prostate cancer occurring with all the other primary tumors in our series.  Lee et al; reported 4.03% finding of prostate cancer in radical cystoprostatectomy specimen (Asian J. Andrology, 2006). Discussion [Cont’d]

8.  The incidence of other primary tumours in the setting of primary liver cell carcinoma is relatively common with a strong clustering of genitourinary and gastro-intestinal malignancies.  Synchronous thyroid tumours have been reported following radiation for head and neck tumours. In our report, it was discovered after External beam radiation therapy to the pelvis.  Prostate cancer with Rectal cancer - Post Radiotherapy - Age Discussion [Cont’d]

9.  Prostate cancer with Colonic tumours - Genetics: (i) mutation of BRCA2 gene (ii) mutation of MMR gene (Lynch syndrome) Discussion [Cont’d]

10.  To make Diagnosis.  Diagnostic tools are limited: availability and affordability.  Between oncologic cure and preservation of functional anatomy/quality of life.  No established guideline.  Poor cancer registry.  Low rate of postmortem and radical procedures. Challenges

11.  MPC occurrence are probably more than the documented cases.  Detailed clinical evaluation is key.  There is need for more multidisciplinary approach to care.  There is also need for genetics study. Conclusion