A Population-Based Study of Secondary Prostate Cancer Risk after Radiotherapy in Male Patients with Rectal Cancer: A Retrospective Cohort Study

Abstract

Background and objective: Risk of secondary prostate cancer after radiation therapy among patients with rectal cancer remains undetermined. Given an increased incidence of rectal cancer in younger people and improved survival for rectal cancer patients who received radiation therapy, the potential risk of secondary prostate cancer needs to be further investigated. Materials and Methods: Male patients (n = 11,367) newly diagnosed rectal cancer and who underwent abdominoperineal resection (APR) or low anterior resection (LAR) from 1 January, 1998 to 31 December, 2010 were identified from Taiwan National Health Insurance Research Database. The incidence and relative risk of secondary prostate cancer in study patients with (n = 1586) and without (n = 9781) radiotherapy within one year after rectal cancer diagnosis were compared using a competing-risks analysis. Results: Rectal cancer patients with radiotherapy were at a significantly decreased risk of developing prostate cancer, with a hazard ratio (HR) of 0.41 (95% confidence interval = 0.20–0.83) after adjustment for age. Analysis of the risk estimated for various follow-up lengths suggested that a decreasing HR was seen through the period followed-up and that there was a trend of decreasing prostate cancer risk with time after radiotherapy. Conclusions: Radiotherapy was significantly associated with decreased risk of secondary prostate cancer among rectal cancer patients, by a magnitude of 59%.

Treatment of rectal cancer after previous prostate cancer: A single institution experience

“…This increased risk was only observed when patients were treated with external beam radiotherapy (EBRT) and not with brachytherapy (6,8,10). Notably, this association does not appear to work in reverse, with lower rates of prostate cancer observed in multiple European and Asian cohort studies of patients who have undergone rectal cancer treatment (10)(11)(12)(13). There may also be poorer outcomes amongst this cohort of patients with rectal cancer who have previously been treated for prostate cancer (7).…”