Risk of second cancer among young prostate cancer survivors

Abstract

Purpose: About 40% of men diagnosed with prostate cancer (Pca) are ≤65 years of age. This study evaluates the risk of second cancer among young Pca patients treated with surgery or radiation.

Materials and methods: This is a retrospective review of 150,915 men aged ≤65 years at Pca diagnosis treated with surgery or radiation registered in the Surveillance, Epidemiology, and End Results (SEER) database between 1973 and 2014. Incidence rates of second rectum/rectosigmoid junction (RJ), bladder, and lung cancer in each treatment group were reported with adjustment for potential confounders. Cumulative incidence functions were used to summarize the risk of second cancer after completing initial treatment.

Results: Men treated with external beam radiation (BEAM), brachytherapy (SEED), or combined radiation all exhibited a statistically significant increased incidence of second bladder cancer compared to men treated with surgery (adjusted incidence rate ratio [IRR]: 2.09, 1.91, and 2.04, respectively). Incidence of rectum/RJ cancer was also significantly increased in men receiving BEAM and combined radiation (adjusted IRR: 1.58 and 1.98, respectively). There were also significant differences in the cumulative incidence of second bladder cancer after receiving any form of radiation compared to surgery.

Conclusion: Pca survivors ≤65 years of age at Pca diagnosis had an increased risk of second bladder and rectum/RJ cancer after BEAM and combined radiation treatment after adjusting for confounding factors. Second bladder cancer incidence after either form of radiation treatment was increased even at 5 years after a Pca diagnosis.

Keywords: Prostate cancer; Prostatectomy; Radiotherapy; Second cancer.

Fig. 1.

Cumulative incidence of second cancer from 12-month post-prostate cancer diagnosis. (A) Any second cancer. (B) Second lung cancer. (C) Second bladder cancer. (D) Second rectum/RJ cancer. BEAM, external beam radiation; SEED, brachytherapy; RJ, rectosigmoid junction.

Fig. 2.

Overall survival and second cancer-free survival. (A) Overall survival after first prostate cancer diagnosis. (B) Second cancer-free survival (over time at risk). BEAM, external beam radiation; SEED, brachytherapy.