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