What is the rectal cancer treatment option for the elderly?

Question

Hello doctor,

My uncle has recently been diagnosed with cancer, and I am currently exploring treatment options and seeking advice from an oncologist. The physician who has been treating him advised that we stop all active treatment, suggesting that he may not have much time left.

We are hoping to get a second opinion or any possible alternatives. One of the doctors who reviewed his biopsy mentioned the following: It appears to be a rectal malignancy, but a PSA (prostate-specific antigen) level and PSA staining of the biopsy tissue would help rule out prostate cancer. If this is rectal cancer, the prognosis is unfortunately not good given the stage. A PCN (percutaneous nephrostomy) might help temporarily by improving creatinine levels and potentially avoiding dialysis. I believe an oncology consult would be best for managing palliative care and keeping him comfortable, pain-free, able to eat, and breathing more easily.

I am not fully sure how to distinguish between prostate cancer and rectal cancer, and would greatly appreciate a professional opinion to help clarify this.

At the moment, my uncle has two external bags: one for stool and one for urine. He underwent surgery for rectal dysfunction approximately 18 years ago and has used a colostomy bag since then. The urinary catheter was added more recently due to complications from kidney stones.

He is in a great deal of discomfort, and I feel helpless. I would be grateful for any guidance or direction you can provide regarding next steps or possible options.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I've reviewed your uncle's reports (attachments removed for patient confidentiality), and I am truly sorry to hear that he is facing such an advanced stage of cancer.

You asked about how to differentiate between prostate cancer and rectal cancer. There are three key diagnostic options we typically consider:

The serum PSA (prostate-specific antigen) test is a non-invasive blood test.
A PSMA PET (prostate-specific membrane antigen positron emission tomography) scan is a non-invasive imaging study that helps detect prostate cancer spread.
TRUS (trans-rectal ultrasound) guided biopsy is a transrectal ultrasound-guided biopsy, which is an invasive but definitive procedure.

Regarding his current symptoms and condition, placing a PCN (percutaneous nephrostomy) is a reasonable and often helpful intervention. Tumors in this region can obstruct the ureters, and a PCN can help relieve that obstruction, improve kidney function (such as lowering creatinine), and possibly prevent the need for dialysis.

Once the primary site is confirmed, whether prostate or rectal, there are palliative treatment options that may help improve quality of life. These may include palliative radiotherapy and metronomic chemotherapy (low-dose, continuous chemotherapy). These treatments are not curative but can provide symptom relief and temporary stabilization.

If the diagnosis is confirmed as prostate cancer, hormonal therapy (androgen deprivation therapy) may be initiated, which often provides good palliative benefit.

Please let me know if you have any further questions or need help coordinating these next steps.

Wishing you and your family strength during this time.

Thank you.