2nd tumors in high risk PCa patients

[pjoshea13]

New study from Spain.

"A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n=145) or radiotherapy and androgen blockade (n=141)."

"The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour."

"The onset of a second primary tumour was related with the primary treatment given; ... the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled."

As Dr Myers once said: "Radiation, the treatment that keeps on giving."

-Patrick

ncbi.nlm.nih.gov/pubmed/301...

Actas Urol Esp. 2018 Aug 14. pii: S0210-4806(18)30187-6. doi: 10.1016/j.acuro.2018.07.002. [Epub ahead of print]

Incidence of second tumours in high risk prostate cancer patients according to the primary treatment applied.

[Article in English, Spanish]

Caño-Velasco J1, Herranz-Amo F2, Barbas-Bernardos G2, Polanco-Pujol L2, Lledó-García E2, Hernández-Fernández C2.

Author information

1

Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: [e-mail].

2

Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.

Abstract

INTRODUCTION AND OBJECTIVES:

The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours.

MATERIAL AND METHODS:

A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n=145) or radiotherapy and androgen blockade (n=141). The homogeneity of both series was analysed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours.

RESULTS:

The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (P=.29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR=2.41, 95%CI: 1.31-4.34, P=.005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors.

CONCLUSIONS:

The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled.

Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

KEYWORDS:

Cáncer de próstata; External radiotherapy; Prostate cancer; Prostatectomy; Prostatectomía; Radioterapia externa; Second tumour; Segundo tumor

PMID: 30119969 DOI: 10.1016/j.acuro.2018.07.002

[cesanon]

Hmmm I had radiation treatment at the Dattoli Clinic in Sarasota.

I have always worried about secondary tumors.

It seems there are no good protocols for keeping an eye open for them.

What do other people do? What tests do you take to keep a watchful eye out for secondary tumors, prostate or non-prostate related?

[Tall_Allen in reply to cesanon]

Retrospective studies (non-randomized, not even case matched) like this aren't worth the paper they are printed on. Radiation patients are usually 10 years older than surgery patients so of course they have more cancer. When you include smoking too, differences usually disappear. Association is not causation. For secondary tumors, it is tremendously difficult to know. All indications is it's a very minor issue. Here's a stab at it:

pcnrv.blogspot.com/2016/08/...

[cesanon in reply to Tall_Allen]

That's interesting.

Thanks for all your high quality contributions to this forum.

[yamobedeh in reply to cesanon]

I also went through the Dattoli program, and just finished my 6 month follow-up. Their thinking is that RT may actually help to prevent some successive tumour growth, at least in the pelvic area.

[cesanon in reply to yamobedeh]

yamobedeh

Did you get your lymph nodes radiated?

Did you get substantially reduced CB4 T Cell levels?

[yamobedeh in reply to cesanon]

If you mean CD4 T cells, I've had no specific testing for those. Currently, I have low values for RBC, WBC, HGB, HCT and Lymphocytes. I expect these levels to rise since stopping Trelstar injections (LHRH) and Casodex. In Canada, super-sensitive PSA testing is not available, so I will need to access testing, likely in Buffalo or others in NY.

I got some RT on LNs as part of the pelvic RT prior to LD brachy, then, 3 months after that, I got 10 RT sessions at lower dosage on pelvic LNs. I think that's the standard model for Dattoli in most cases.

[cesanon in reply to yamobedeh]

You may want to get a test on your car t cell levels.

If you do please share your results.

I had basically similar therapy to yours at Dattoli. Somehow I ended up with cd4 t cell levels under 200 which is the same as an aids patient.

My hypothesis is that they got killed during the lymph node irradiation. Once killed, this particular type of T cell never regenerates or grows back.

[j-o-h-n]

I'm a statistic... Pca and then Lung Melanoma.... related or not? Only God knows and he/she ain't telling.

dailymotion.com/video/x16zf3o

Good Luck and Good Health.

J-o-h-n Monday 08/20/2018 1:14 PM EDT