How do you treat synchronous rectal cancer and prostate cancer?

There are several case reports describing the treatment of localized synchronous prostate and rectal cancer. Combined radical retropubic prostatectomy and rectal resection has been described but is associated with high morbidity (Klee et al.). Definitive external beam chemoradiation therapy with 5-F...

One approach that I have used for similar cases (for a very small n=2) involved treating the rectal cancer with preop RT (50.4 Gy to standard rectal fields) with capecitabine, but modifying the coverage around the prostate to include prostate+8 mm. External iliac LNs were not included. Dose to the p...

Are there any updates to this question? Also, would the recommendation differ if the prostate cancer was low/very low risk and the patient was otherwise a good candidate for active surveillance?