UROLOGICAL SURVEY
Urological Oncology
Secondary cancer after radiotherapy for prostate cancer: should we be more aware of the risk?
Bostrom PJ, Soloway MS
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
Eur Urol. 2007; 52: 973-82
OBJECTIVES: As the number of prostate cancer survivors is increasing, the long-term health of prostate cancer patients has become a significant health issue. Radiation is known to induce malignant transformation, and prostate cancer radiotherapy is suggested to induce secondary malignancies. This report reviews the available data regarding the risk of secondary cancer after radiation for prostate cancer.
METHODS: Epidemiological studies of the secondary cancer risk in patients with a history of prostate cancer radiation and the literature regarding radiation-induced carcinogenesis were reviewed.
RESULTS: Prostate cancer is not associated with an increased number of additional malignancies. The data suggests a modest increase in secondary cancers associated with radiation for prostate cancer, as approximately one in 70 patients undergoing radiation and surviving more than 10 yr will develop secondary cancer. The most common sites for secondary cancers are bladder and rectum. In addition to the cancers adjacent to the radiation field, there is also an increase of cancers in distant sites, such as lung. The increased risk for secondary cancers is reported after external radiation, not after brachytherapy. The available data originated from studies of patients undergoing conventional radiotherapy. New treatment methods, such as intensity-modulated radiotherapy, may be associated with a higher risk of secondary cancers.
CONCLUSION: Although the incidence of secondary cancers after prostate cancer radiotherapy is not dramatically different from the overall population, patients should be informed about this risk. Other treatment modalities should be considered for patients with long life expectancy and for patients with additional risk factors.
Editorial Comment
Long-term survival after radiotherapy for prostate cancer is not uncommon. The risk of secondary cancers contributable to radiotherapy was analyzed in this review of the literature.
First, the authors analyzed the association of prostate cancer with secondary cancers. In 7 reports on roughly 90,000 patients, no elevation of risk for secondary cancers was obvious. The next analysis involved roughly 32,000 patients who had received radiation therapy for prostate cancer. In this cohort, the authors found a slight increase of the risk to develop a secondary cancer in areas involving the radiation field, specifically the bladder and rectum with a risk ratio of approximately 1:5. Interestingly, an increased risk was also seen for lung cancer. These data mandate long-term follow-up examinations of the specific sites, that are bladder, rectum and lung, after radiotherapy for prostate cancer.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Outcome of prostate cancer patients with initial PSA> or =20 ng/ml undergoing radical prostatectomy
Zwergel U, Suttmann H, Schroeder T, Siemer S, Wullich B, Kamradt J, Lehmann J, Stoeckle M
Department of Urology and Pediatric Urology, University of Saarland, Hamburg/Saar, Germany
Eur Urol. 2007; 52: 1058-65
OBJECTIVES: To retrospectively assess the outcome of patients with initial PSA of 20 ng/ml or higher undergoing radical prostatectomy (RP) for prostate cancer (pCA).
METHODS: Between January 1986 and June 2005, 275 patients with preoperative PSA> or =20 ng/ml underwent RP for pCA at our institution. Overall, disease-specific and biochemical progression-free survival rates for the entire cohort and for particular subgroups were determined.
RESULTS: Median patient age at time of surgery was 64 yr (range: 44-75). Fifty-seven patients (20.7%) had pT2 stage, 206 (74.9%) pT3, and 10 (3.7%) pT4; 78 (28.4%) presented with local nodal metastases (pN+). To date, 40 patients have died (14.5%), 22 of pCA and 18 of other causes. Biochemical progression occurred in 92 patients (33.5%). Overall (and disease-specific) survivals at 5, 10, and 15 yr were 87% (93%), 70% (83%), and 58% (71%), respectively. These survival rates did not significantly differ between patients receiving immediate versus deferred hormonal therapy (in case of progression). Five-year PSA progression-free survival in patients on surveillance (receiving deferred hormonal treatment at the onset of rising PSA values) was 53%. For patients on immediate hormonal treatment following RP, the 5-yr hormone-refractory PSA progression rate was 76%.
CONCLUSIONS: According to long-term follow-up results in this high-risk cohort of patients with preoperative PSA > or = 20 ng/ml, RP can be considered a viable therapeutic option. With regard to combining immediate hormonal therapy with surgery, the optimal treatment following RP remains to be defined.
Editorial Comment
The authors report on a series of 275 prostate cancer patients who received radical prostatectomy (RP) with a preoperative PSA of > 20 ng/ml. The patients had bone scans preoperatively, but MRI or CT was offered only in case of clinically suspected metastatic disease. Only 20.7% of patients had organ-confined disease, whereas 74.9 % had pT3 cancer (with pT3b in 43.9%). Only 7.6% had Gleason sum score of 5 and 6 whereas Gleason 7 was seen in 43,3% and Gleason 9 in 28.1 %. Interestingly, even in this high-risk group of patients, cancer-specific survival after 5, 10 and 15 years was 93%, 83% and 71%, respectively. No difference was seen between cohorts receiving immediate versus deferred hormon-ablative therapy. These data support active therapy in patients with high-risk cancer.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Publication Dates
-
Publication in this collection
25 Mar 2009 -
Date of issue
Feb 2009
