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UPJ Insight Risk and Prognostics of Second Primary Cancer After Prostate Radiation Therapy
By: Elisa K. Liu, MD, NYU Grossman School of Medicine, New York, New York; Thomas B. Daniels, MD, NYU Grossman School of Medicine, New York, New York; Jonathan W. Lischalk, MD, NYU Long Island School of Medicine, Mineola, New York; Cheongeun Oh, PhD, NYU Grossman School of Medicine, New York, New York; Jonathan A. Haas, MD, NYU Long Island School of Medicine, Mineola, New York; Andrew J. Evans, MD, NYU Grossman School of Medicine, New York, New York; David J. Byun, MD, NYU Grossman School of Medicine, New York, New York | Posted on: 19 Jan 2024
Liu EK, Daniels TB, Lischalk JW, et al. Risk and prognostics of second primary cancer after prostate radiation therapy. Urol Pract. 2024;11(1):145-152.
Study Need and Importance
As overall survival in prostate cancer increases due to advances in early detection and management, there is a growing need to understand the long-term morbidity associated with treatment, including secondary tumors. However, prior studies identifying increase in risk of second primary cancer after prostate radiation do not account for death as a competing risk; as radiation-induced cancers often occur years to decades after the initial radiation treatment, failure to account for competing events may falsely increase estimates of second primary tumors. As prostate cancer can be diagnosed in a wide, albeit older, range of patients, how the prognostic significance of developing secondary tumors is affected by patient characteristics is also unknown.
What We Found
In our study, we utilized the Surveillance, Epidemiology, and End Results data to assess the risk of secondary pelvic tumors in prostate cancer patients who underwent radiation therapy. Interestingly, our estimate that 1.8% and 1.1% of patients, with or without radiation, will develop secondary pelvic tumors at 25 years after initial treatment is lower than previously reported, possibly due to our method of treating death as a competing risk and subsequently removing patients who die during the study period from the at-risk population (Figure). Our results also confirmed that the development of secondary tumors significantly impairs overall survival, particularly in younger patients.
Limitations
Our study is limited by the retrospective nature of the database analyzed and lack of important covariables, including comorbidity scores, radiation treatment regimen, or molecular phenotypes.
Interpretations for Patient Care
As radiation remains an overall highly effective, well-tolerated, and necessary component of prostate cancer management, our study supports a robust and nuanced risk-benefit discussion with an emphasis on surveillance for delayed sequelae of radiation, especially among patients who are younger with limited comorbidities.
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