External Beam Radiotherapy Increases the Risk of Bladder Cancer When Compared with Radical Prostatectomy in Patients Affected by Prostate Cancer: A Population-based Analysis.

Published on Feb 1, 2019in European Urology17.947
· DOI :10.1016/J.EURURO.2018.09.034
Marco Moschini27
Estimated H-index: 27
(Medical University of Vienna),
Emanuele Zaffuto16
Estimated H-index: 16
(UdeM: Université de Montréal)
+ 8 AuthorsShahrokh F. Shariat132
Estimated H-index: 132
Abstract Background Long-term survival can be achieved in patients affected by localized prostate cancer (PCa) treated with either radical prostatectomy (RP) or external beam radiotherapy (EBRT). However, development of a second primary tumor is still poorly investigated. Objective To investigate the impact of RP and EBRT on subsequent risk of developing bladder (BCa) and/or rectal cancer (RCa) among PCa survivors. Design, setting, and participants A total of 84397 patients diagnosed with localized PCa, treated with RP or EBRT between 1988 and 2009, and older than 65 yr of age were identified in the Surveillance, Epidemiology, and End Results Medicare insurance program-linked database. Our primary objective was to investigate the effect of EBRT and RP on the second primary BCa and RCa incidence. Outcome measurements and statistical analysis Multivariable competing-risk regression analyses were performed to assess the risk of developing a second primary BCa or RCa. Results and limitations Of the 84397 individuals included in the study, 33252 (39%) were treated with RP and 51145 (61%) with EBRT. Median follow-up was 69 months, and follow-up periods for patients who did not develop BCa, RCa, or pelvic cancer were 68, 69, and 68 mo, respectively. A total of 1660 individuals developed pelvic tumors (1236 BCa and 432 RCa). The 5- and 10-yr cumulative BCa incidence rates were 0.75% (95% confidence interval [CI]: 0.64–0.85%) and 1.63% (95% CI: 1.45–1.80%) versus 1.26% (95% CI: 1.15–1.37%) and 2.34% (95% CI: 2.16–2.53%) for patients treated with RP versus EBRT, respectively. The 5- and 10-yr cumulative RCa incidence rates were 0.32% (95% CI: 0.25–0.39%) and 0.73% (95% CI: 0.61–0.85%) versus 0.36% (95% CI: 0.30–0.41%) and 0.69% (95% CI: 0.60–0.79%) for patients treated with RP versus EBRT, respectively. On multivariable competing risk regression analyses, treatment with EBRT was independently associated with the risk of developing a second primary BCa (hazard ratio: 1.35, CI: 1.18–1.55; p Conclusions Patients treated with EBRT are at increased risk of developing a second primary BCa compared with those treated with RP. However, no differences were found considering RCa incidence in patients treated with RP or EBRT within the first 5 yr after primary therapy. These results need to be validated in a well-designed randomized prospective trial. Patient summary We retrospectively analyzed the risk of developing a second primary bladder or rectal cancer during follow-up for patients treated with radical prostatectomy or external beam radiotherapy for a localized prostate cancer. We found that those treated with external beam radiotherapy are at an increased risk of developing a second primary bladder cancer tumor.
📖 Papers frequently viewed together
13 Citations
20152.74PLOS ONE
12 Authors (Satoru Taguchi, ..., Yukio Homma)
11 Citations
69 Citations
#1Phillip J. GrayH-Index: 10
#2Chun Chieh Lin (ACS: American Cancer Society)H-Index: 21
Last. Jason A. Efstathiou (Harvard University)H-Index: 55
view all 5 authors...
Abstract Background Numerous management options exist for patients with prostate cancer; however, recent trends and their influencing factors are not well described. Objective To describe modern patterns of care and factors associated with management choice using the National Cancer Database. Design, setting, and participants Patients with localized prostate cancer diagnosed between 2004 and 2012 were included and grouped according to National Comprehensive Cancer Network guidelines into low, in...
72 CitationsSource
#1Nicolas MottetH-Index: 40
#2Joaquim Bellmunt (Harvard University)H-Index: 87
Last. Philip CornfordH-Index: 27
view all 22 authors...
Abstract Objective To present a summary of the 2016 version of the European Association of Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Guidelines on screening, diagnosis, and local treatment with curative intent of clinically localised prostate cancer (PCa). Evidence acquisition The working panel performed a literature review of the new data (2013–2015). The guidelines were updated and the levels of evidence and/or gra...
2,074 CitationsSource
#1Nicholas M. Donin (UCLA: University of California, Los Angeles)H-Index: 15
#2Christopher P. Filson (VA: United States Department of Veterans Affairs)H-Index: 20
Last. Karim ChamieH-Index: 27
view all 8 authors...
BACKGROUND In the current study, the authors attempted to describe the incidence, most common sites, and mortality of second primary malignancies among survivors of common cancers. METHODS The authors identified patients aged ≥18 years who were diagnosed with a primary malignancy from the 10 most common cancer sites (prostate, breast, lung, colon, rectum, bladder, uterus, kidney, melanoma, and non-Hodgkin lymphoma) between 1992 and 2008 from Surveillance, Epidemiology, and End Results data. Fact...
126 CitationsSource
#1Freddie C. Hamdy (University of Oxford)H-Index: 94
#2Jenny L Donovan (UoB: University of Bristol)H-Index: 106
Last. David E. Neal (University of Cambridge)H-Index: 111
view all 27 authors...
BackgroundThe comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. MethodsWe compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active m...
1,363 CitationsSource
#1Marcus G. Cumberbatch (University of Sheffield)H-Index: 15
#2Matteo RotaH-Index: 30
Last. Carlo La Vecchia (University of Milan)H-Index: 135
view all 4 authors...
Abstract Context Tobacco smoke includes a mix of carcinogens implicated in the etiology of bladder cancer (BC) and renal cell cancer (RCC). Objective We reviewed the impact of tobacco exposure on BCC and RCC incidence and mortality, and whether smoking cessation decreases the risk. Evidence acquisition A systematic review of original articles in English was performed in August 2013. Meta-analysis of risks was performed using adjusted risk ratios where available. Publication bias was assessed usi...
151 CitationsSource
#1Marco Moschini (UniSR: Vita-Salute San Raffaele University)H-Index: 27
#2Nicola Fossati (UniSR: Vita-Salute San Raffaele University)H-Index: 36
Last. Firas Abdollah (Vattikuti Urology Institute)H-Index: 64
view all 14 authors...
Abstract Background Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. Objective We evaluated the nationwide utilization rate of AS in the contemporary era. Design, setting, and participants We relied on the 2010–2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-...
11 CitationsSource
#1Marco Moschini (Mayo Clinic)H-Index: 27
#2Vidit Sharma (Mayo Clinic)H-Index: 15
Last. R. Jeffrey Karnes (Mayo Clinic)H-Index: 70
view all 10 authors...
Purpose: Lymph node positive (pN+) prostate cancer after radical prostatectomy has wide variability in long-term oncologic outcomes. We present a large institutional series with extended followup to create an oncologic risk stratification system that clarifies the prognostic heterogeneity for patients with pN+ disease after radical prostatectomy.Materials and Methods: Men with pN+ prostate cancer after radical prostatectomy during 1987 to 2012 were included in the study. Regression models were c...
22 CitationsSource
#1Peter R. Carroll (UCSF: University of California, San Francisco)H-Index: 141
#2J. Kellogg Parsons (UCSD: University of California, San Diego)H-Index: 43
Last. Deborah A. Freedman-Cass (National Comprehensive Cancer Network)H-Index: 27
view all 32 authors...
Abstract The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer Early Detection provide recommendations for prostate cancer screening in healthy men who have elected to participate in an early detection program. The NCCN Guidelines focus on minimizing unnecessary procedures and limiting the detection of indolent disease. These NCCN Guidelines Insights summarize the NCCN Prostate Cancer Early Detection Panel's most significant discussions for the 2016 guideline up...
216 CitationsSource
#1Christopher J.D. Wallis (U of T: University of Toronto)H-Index: 24
#2Alyson L. Mahar (Sunnybrook Health Sciences Centre)H-Index: 23
Last. Robert K. Nam (Sunnybrook Health Sciences Centre)H-Index: 54
view all 9 authors...
Objective To determine the association between exposure to radiotherapy for the treatment of prostate cancer and subsequent second malignancies (second primary cancers). Design Systematic review and meta-analysis of observational studies. Data sources Medline and Embase up to 6 April 2015 with no restrictions on year or language. Study selection Comparative studies assessing the risk of second malignancies in patients exposed or unexposed to radiotherapy in the course of treatment for prostate c...
119 CitationsSource
#1Jae Young JoungH-Index: 15
#2Jiwon LimH-Index: 8
Last. Young-Joo WonH-Index: 10
view all 11 authors...
As patients with prostate cancer have a long life expectancy, there is increasing interest in predicting the risk of development of a second primary cancer (SPC), and we therefore designed this study to estimate the overall risk of developing SPCs among Korean prostate cancer patients. We used a population-based cohort from the Korean Central Cancer Registry composed of 55,378 men diagnosed with a first primary prostate cancer between 1993 and 2011. Standardized incidence ratios (SIRs) of SPCs w...
19 CitationsSource
Cited By24
#1Giulio FrancoliniH-Index: 13
#2Lucia Pia CicconeH-Index: 3
Last. Lorenzo LiviH-Index: 28
view all 10 authors...
#1Prithvi B. Murthy (Cleveland Clinic)H-Index: 4
#2Zaeem Lone (Cleveland Clinic Lerner College of Medicine)H-Index: 1
Last. JJ H. Zhang (Cleveland Clinic)H-Index: 3
view all 15 authors...
Abstract null null Objectives null To determine the impact of prior pelvic radiation therapy (XRT) on outcomes following radical cystectomy (RC) for bladder cancer. null null null Materials and methods null We performed a retrospective review comparing patients with bladder cancer requiring RC and prior history of XRT for prostate cancer to those undergoing RC without XRT history at our institution from 2011-2018. Propensity score matching was performed with the following variables: age, chronic...
OBJECTIVES To investigate the race-specific second primary bladder cancer (SPBC) risk following prostatic irradiation. METHODS Louisiana residents who were diagnosed with localized prostate cancer (PCa) in 1996-2013 and received surgery or radiation were included. Patients were followed until SPBC diagnosis, death, or Dec. 2018. The exposure variable was type of treatment (radiation only vs. surgery only). The outcome was time from PCa diagnosis to SPBC diagnosis, stratified by race. Fine and Gr...
#1Edward Christopher Dee (Harvard University)H-Index: 6
#2Vinayak Muralidhar (Brigham and Women's Hospital)H-Index: 16
Last. Jonathan E. Leeman (Brigham and Women's Hospital)H-Index: 16
view all 9 authors...
BACKGROUND Prostate radiotherapy has been associated with an increased risk of developing a second malignancy (SM). However, relative SM probabilities following treatment with contemporary radiation techniques such as stereotactic body radiotherapy (SBRT) or moderately hypofractionated intensity modulated radiotherapy (HF-IMRT) remain unknown. METHODS A cohort analysis was performed of men from a nationally representative database with localized prostate cancer with at least 60 months of follow-...
1 CitationsSource
#1M Levitt (U of O: University of Ottawa)
#2Ameeta L. Nayak (U of O: University of Ottawa)
Last. Rodney H. Breau (Ottawa Hospital Research Institute)H-Index: 28
view all 8 authors...
Abstract null null Introduction null Despite the proven benefit of adjuvant androgen deprivation therapy (ADT) for patients receiving primary radiation, there are few studies evaluating adjuvant ADT after prostatectomy. In the absence of evidence, opinions and practice patterns vary. We surveyed Canadian prostate cancer surgeons about their use of adjuvant ADT and their opinions on the design of a potential adjuvant ADT trial. null null null Methods null An electronic survey was devised and dist...
#1David Angelats Lobo (University of Brescia)H-Index: 2
#2Paola Ginestra (University of Brescia)H-Index: 10
Last. Joaquim Ciurana (University of Girona)H-Index: 31
view all 5 authors...
Three-dimensional printing technologies allow for the fabrication of complex parts with accurate geometry and less production time. When applied to biomedical applications, two different approaches, known as direct or indirect bioprinting, may be performed. The classical way is to print a support structure, the scaffold, and then culture the cells. Due to the low efficiency of this method, direct bioprinting has been proposed, with or without the use of scaffolds. Scaffolds are the most common t...
#1Adam B. Weiner (NU: Northwestern University)H-Index: 14
#2Eric V. Li (NU: Northwestern University)H-Index: 2
Last. Edward M. Schaeffer (NU: Northwestern University)H-Index: 59
view all 5 authors...
BACKGROUND More than 3.6 million men in the United States harbor a diagnosis of prostate cancer (PCa). The authors sought to provide in-depth analyses of the causes of death for contemporary survivors. METHODS The authors performed a population-based cohort study in the United States (2000-2016) to assess causes of death for men diagnosed with PCa stratified by demographics and tumor stage. Using general population data, they calculated standardized mortality ratios (SMRs) as observed-to-expecte...
3 CitationsSource
#1Sybil Sha (Dartmouth College)H-Index: 2
#2Edward Christopher Dee (Brigham and Women's Hospital)H-Index: 6
Last. Vinayak Muralidhar (Brigham and Women's Hospital)H-Index: 16
view all 12 authors...
ABSTRACT Objective To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC. Methods We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database a...
1 CitationsSource
#1Deqiang Pan (Zhengzhou University)
Last. Guang Zhu
view all 6 authors...
ABSTRACT To achieve a deeper understanding of patients who developed esophageal cancer (EC) as a second primary malignancy, which may help guide in clinical practice for these patients in the future.In the primary cohort, EC patients with a prior malignancy were identified from the surveillance, epidemiology, and end result 18 database. The 5 most common types of prior cancers were picked out based on the frequency of occurrence. In addition, Kaplan-Meier and log-rank tests were performed to inv...