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The case describes a patient with major comorbidities and simultaneous metastatic prostate and colorectal adenocarcinomas achieving sustained complete remission of liver and lung metastases using a chemotherapy-hormonal regimen.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/managing-elderly-patients-with-dual-metastatic-cancers-navigating-diagnostic-and-treatment-challenges/372192/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/managing-elderly-patients-with-dual-metastatic-cancers-navigating-diagnostic-and-treatment-challenges/372192.png","ImageObject",300,407,{"name":42,"@type":43},"Asher","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-27","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",15,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why 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Nicholas Levonyak1,4, Liwei Jia2, Richard Ahn3,, Jyoti Balani2, Jue Wang*, 1,4,  \n1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8852, United States, 2Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390-8852, United States, 3Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390-8852, United States,  \n4 Hematology-Oncology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8852, United States  \n* Corresponding author: Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd. Dallas, TX 75390-8852, USA ([jue.wang@utsouthwestern.edu](jue.wang@utsouthwestern.edu)) .  \nAbstract  \nProstate and colorectal adenocarcinoma are among the most common primary cancer diagnoses in the United States, with 29% of new cancer diagnoses among adult men in 2024 expected to arise from the prostate and another 15% across men and women being colorectal in origin. Given therapeutic advancements leading to improved survival, individuals with prostate cancer have the highest estimated probability of concurrent secondary primary malignancy. This represents a clinical dilemma as the treatment for each is distinct and impacted by histology, stage, and molecular findings. Herein, we describe a patient with significant comorbidities, found to have simultaneous metastatic prostate and colorectal adenocarcinomas, who achieved sustained complete remission of liver and lung metastases with achemohormonal regimen.  \nKey words: prostate adenocarcinoma; colorectal adenocarcinoma; metastatic cancer; molecular diagnostics; precision oncology.  \nKey Points  \n- The case highlights the importance of utilizing advanced imaging techniques, morphologic analysis, pathology, and molecular profiling to overcome diagnostic challenges in managing complex cases of dual primary cancers.  \n- It underscores the challenges of relying solely on clinical guidelines and trial-based protocols, particularly when dealing with stage 4 double primary malignancies that are often underrepresented in most clinical trials, requiring a more flexible, individualized approach.  \n- When a combination therapy for two different cancers is not feasible, the case emphasizes the potential benefit of using a single regimen that can target both cancers, offering a “one stone, two birds” approach to treatment.  \nPatient presentation  \nA 70-year-old male with non-ischemic cardiomyopathy and chronic systolic heart failure requiring cardiac resynchronization therapy defibrillator (CRT-D) placement in India presented to the emergency department with dysuria, urinary retention, rectal pain and marked deconditioning. Computed tomography (CT) imaging was remarkable for a heterogeneously enhancing prostate and multiple bibasilar pulmonary nodules measuring up to 10 mm. Figure 1A,B. There was concern for metastatic prostate cancer, but the prostate-specific antigen (PSA) level was only modestly elevated at 6.4 ng/mL. The patient was discharged and referred to Urology for follow up.  \nThe patient returned to the emergency department approximately one month later, with worsening rectal pain and bleeding. CT of the chest demonstrated significant interval progression of innumerous well circumscribed bilateral solid  \ncannonball pulmonary nodules of various sizes, now seen in all lobes of the lung, measuring up to 2.2 cm. A repeat CT abdomen also showed new hypoattenuating lesions in segment VI of the liver worrisome for further metastatic spread. Figure 1C,E  \nMolecular Tumor Board  \nA colonoscopy showed an infiltrating, non-obstructive mass 2.0 cm long within the ascending colon. Biopsy of this revealed moderately differentiated invasive colorectal adenocarcin","cbCaisv4euHKj8B4","https://ap.wps.com/l/cbCaisv4euHKj8B4","pdf",931041,"English","# Abstract\n# Key Points\n# Patient presentation\n## Initial emergency visit and imaging findings\n## Return with progression and new metastases\n# Molecular Tumor Board\n## Colonoscopy and biopsy results\n## Liver biopsy findings\n# Publication and licensing notes","[{\"question\":\"Why is managing dual metastatic prostate and colorectal cancers clinically challenging?\",\"answer\":\"Each cancer requires distinct treatment decisions influenced by histology, stage, and molecular findings, making standard approaches difficult to unify.\"},{\"question\":\"What imaging and lab signals were used in the initial presentation?\",\"answer\":\"Computed tomography showed a heterogeneously enhancing prostate and multiple pulmonary nodules, while PSA was only modestly elevated at 6.4 ng/mL.\"},{\"question\":\"How did molecular profiling contribute to diagnosis in the case?\",\"answer\":\"Next-generation sequencing identified KRAS G12D and SMAD4 C363Y mutations from colon biopsy, and liver biopsy showed a poorly differentiated carcinoma, supporting the dual malignancy framework.\"}]","Managing elderly patients with dual metastatic cancers - navigating diagnostic and treatment challenges | PDF",1790193940]