Radiation Therapy for Prostate Cancer Increases Subsequent Risk of Bladder and Rectal Cancer: A Population Based Cohort Study
ABSTRACT Pre-prostate specific antigen era series demonstrated an increased risk of bladder cancer and rectal cancer in men who received radiotherapy for prostate cancer. We estimated the risk of secondary bladder cancer and rectal cancer after prostate radiotherapy using a contemporary population based cohort.
We identified 243,082 men in the Surveillance, Epidemiology and End Results database who underwent radical prostatectomy or radiotherapy for prostate cancer between 1988 and 2003. We estimated the incidence rate, standardized incidence ratio and age adjusted incidence rate ratio of subsequent bladder cancer and rectal cancer associated with radical prostatectomy, external beam radiotherapy, brachytherapy, and a combination of external beam radiotherapy and brachytherapy.
The relative risk of bladder cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.88, 1.52 and 1.85, respectively. Compared to the general United States population the standardized incidence ratio for bladder cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.99, 1.42, 1.10 and 1.39, respectively. The relative risk of rectal cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.26, 1.08 and 1.21, respectively. The standardized incidence ratio for rectal cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.91, 0.99, 0.68 and 0.86, respectively.
Men who receive radiotherapy for localized prostate cancer have an increased risk of bladder cancer compared to patients undergoing radical prostatectomy and compared to the general population. The risk of rectal cancer is increased in patients who receive external beam radiotherapy compared to radical prostatectomy. Patients should be counseled appropriately regarding these risks.
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ABSTRACT: Objective: To investigate the risk of radiation-induced secondary malignancy in patients with prostate cancer. Methods: We identified 690 references from PubMed, Embase and the Cochrane Library before August 1, 2012, that reported secondary malignancy in patients with prostate cancer after receiving radiation therapy (RT), and finally four studies were included. We calculated summary estimates using random-effects meta-analysis. Results: The overall standardized incidence ratio (SIR) of secondary malignancy in patients with prostate cancer receiving RT to the general population was 1.14 (95% CI 1.04-1.32). In the subgroup analysis, no increment in radiation-induced secondary malignancy risk was detected. In terms of SIR with different follow-up intervals, there was no difference in SIR (>6 months; <5 years) (SIR = 1.19, 95% CI 0.75-1.89) and SIR (>5 years; <10 years) (SIR = 1.39, 95% CI 0.87-2.23). When the follow-up extended to >10 years, a significantly increased secondary malignancy risk was observed (SIR = 1.45, 95% CI 1.23-1.72). There is no significantly increased secondary malignancy risk in patients receiving no RT. Conclusion: RT is associated with increased secondary malignancy in patients with prostate cancer; this effect only become conspicuous more than 10 years after treatment. © 2014 S. Karger AG, Basel.Urologia Internationalis 08/2014; 93(3). DOI:10.1159/000356115 · 1.15 Impact Factor
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ABSTRACT: To compare the second malignancy incidence in prostate cancer patients treated with brachytherapy (BT) relative to radical prostatectomy (RP) and to compare both groups with the cancer incidence in the general population.International journal of radiation oncology, biology, physics 09/2014; 90(4). DOI:10.1016/j.ijrobp.2014.07.032 · 4.18 Impact Factor