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Perianal Paget’s disease (PPD) is a rare skin adenocarcinoma that arises in the apocrine glands of the perianal region. It is often misdiagnosed as eczema, leukoplakia, squamous cell carcinoma, Bowen’s disease, lichen planus, or condylomata acuminata. We report a case of a 63-year-old male who presented to the emergency room (ER) for evaluation of an anal mass that had persisted over 6 months. The patient was found to have a rectal adenocarcinoma with pagetoid spread and underwent neoadjuvant chemoradiation with symptom improvement. However, the patient declined further chemotherapy and the planned abdominal perineal resection with reconstruction, as it would require a permanent colostomy.

Prostate cancer is the most common noncutaneous cancer affecting men in the United States. It is a slow-growing tumor that can be missed during the nascent phase. Prostate cancer commonly metastasizes to the bones and nearby lymph nodes. However, cases of metastatic prostate cancer to the rectum are exceptionally rare. Such metastases may cause obstructive or malabsorption symptoms similar to those observed in primary rectal carcinoma. We present a very rare case of prostate cancer recurrence with rectal metastasis in an elderly male with a history of castration-resistant prostate carcinoma status postradical prostatectomy.