The Rate of Secondary Malignancies After Radical Prostatectomy Versus External Beam Radiation Therapy for Localized Prostate Cancer: A Population-Based Study on 17,845 Patients
Received 25 August 2008; received in revised form 6 February 2009; accepted 7 February 2009.
Purpose
External-beam radiation therapy (EBRT) may predispose to secondary malignancies that include bladder cancer (BCa), rectal cancer (RCa), and lung cancer (LCa). We tested this hypothesis in a large French Canadian population-based cohort of prostate cancer patients.
Methods and Materials
Overall, 8,455 radical prostatectomy (RP) and 9,390 EBRT patients treated between 1983 and 2003 were assessed with Kaplan-Meier and Cox regression analyses. Three endpoints were examined: (1) diagnosis of secondary BCa, (2) LCa, or (3) RCa. Covariates included age, Charlson comorbidity index, and year of treatment.
Results
In multivariable analyses that relied on incident cases diagnosed 60 months or later after RP or EBRT, the rates of BCa (hazard ratio [HR], 1.4; p = 0.02), LCa (HR, 2.0; p = 0.004), and RCa (HR 2.1; p <0.001) were significantly higher in the EBRT group. When incident cases diagnosed 120 months or later after RP or EBRT were considered, only the rates of RCa (hazard ratio 2.2; p = 0.003) were significantly higher in the EBRT group. In both analyses, the absolute differences in incident rates ranged from 0.7 to 5.2% and the number needed to harm (where harm equaled secondary malignancies) ranged from 111 to 19, if EBRT was used instead of RP.
Conclusions
EBRT may predispose to clinically meaningfully higher rates of secondary BCa, LCa and RCa. These rates should be included in informed consent consideration.
∗Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
†Department of Urology, University of Montreal, Montreal, Canada
‡Department of Urology, Vita-Salute San Raffaele, Milan, Italy
§Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
¶Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
Reprint requests to: Pierre I. Karakiewicz, M.D., FRCSC., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montréal, Québec, Canada, H2X 3J4. Tel: (514) 890-8000-35336; Fax: (514) 412-7363
Drs. Bhojani and Capitano contributed equally to this work.
Dr. Pierre I. Karakiewicz is partially supported by the University of Montreal Urology Associates, Fonds de la Recherche en Santé du Québec, the University of Montreal, Department of Surgery and the University of Montreal Foundation.
ABSTRACT