International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationIncreasing Age and Treatment Modality Are Predictors for Subsequent Diagnosis of Bladder Cancer Following Prostate Cancer Diagnosis
Introduction
There are nearly 220,000 new prostate cancer diagnoses each year (1). Some patients with favorable prognosis prostate cancer choose active surveillance without any directed therapy. Most patients, however, chose aggressive treatment (2) with either radiation therapy, surgery, or in some cases surgery followed by radiation therapy.
Since aggressive therapy carries attendant but differing morbidity 3, 4, 5, 6, patients must carefully consider the risks and side effects of each treatment modality. Given the excellent long term disease-free survival (7) and quality of life outcomes with either surgery- or radiation-based approaches 8, 9, consideration of the late effects of therapy is appropriate. A particularly worrisome potential effect of prostate irradiation is radiation-induced second malignancy. Studies reporting the incidence of bladder cancer following prostate cancer 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 have yielded conflicting results, with both positive and negative study outcomes. Several publications have shown that bladder cancer incidence increases following prostatic external beam irradiation 10, 14, 19, 20, 21, 22. On the basis of such positive studies, some authors argue for early and frequent bladder cancer surveillance (24).
However, aside from treatment modality, there are other confounders that may contribute to the risk for subsequent bladder cancer diagnosis after a diagnosis of prostate cancer. Increasing age, smoking, common etiologic genetic factors, and intensity and duration of follow-up have been implicated 17, 25, 26.
This analysis of the Surveillance, Epidemiology, and End Results (SEER) registry was performed to determine the effects of types of prostate therapy (external beam irradiation, surgery, both, or neither) on the actuarial incidence of bladder cancer. These data could be used to (1) counsel patients about their risk of developing bladder cancer over a variety of time points and (2) generate risk-stratified, follow-up guidelines.
Section snippets
Methods and Materials
The SEER program database was used to identify patients for this study. Data from 1973 to 2005 from 17 SEER tumor registries were used (San Francisco [Oakland Standard Metropolitan Statistical Area], Connecticut, Metropolitan Detroit, Hawaii, Iowa, New Mexico, Seattle [Puget Sound], Utah, Metropolitan Atlanta, Alaska, San Jose-Monterey, Los Angeles, rural Georgia, greater California, Kentucky, Louisiana, and New Jersey). Cases were available only for 1974 to 2005 for Seattle (Puget Sound), for
Results
A total of 555,337 patients were diagnosed with pathology confirmed prostatic carcinomas in the SEER database from 1973 to 2005. These data exclude patients who received any brachytherapy as a part of treatment for prostate cancer. Also excluded were patients diagnosed with simultaneous bladder and prostate cancers. This includes 137 patients treated with radiation alone, 631 patients managed surgically, 144 men who received both surgery and radiation, and 280 men who did not receive either
Discussion
This SEER database review is the largest to evaluate the risk of subsequent bladder cancer following diagnosis of prostate cancer, with over 555,000 men included. Men were evaluated for their risk for bladder cancer according to the type of treatment received (external beam irradiation, surgery, both, or neither). To our knowledge, this is the first study to investigate the risk for subsequent bladder cancer after combined surgery and adjuvant external beam irradiation. The overall incidence of
Conclusions
Following prostate cancer, increasing age and irradiation were highly significant predictors of being diagnosed with bladder cancer. These analyses confirm that the actual risk of subsequent bladder cancer following use of radiation in the treatment of prostate cancer is very low. The actuarial statistics provided can be used in informed decision making with patients prior to treatment and in considering the need for cystoscopic surveillance in men following treatment. The low overall incidence
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Cited by (0)
Conflict of interest: none.