Second tumor after prostate cancer therapy?

Less bladder and colon cancer after brachytherapy than after surgery and irradiation

The risk of developing bladder or rectal cancer as a second tumor after prostate radiation using brachytherapy is lower than after complete removal of the prostate. This is the result of a recent US study published in the renowned British Journal of Urology.

The fear that a second tumor will develop after successful treatment of prostate cancer is deep in many men. Especially radiotherapeutic methods are discredited in favour of promoting the occurrence of intestinal and bladder cancer. Wrong,"says Dr. Pedram Derakhshani, urologist at the West German Prostate Center. Thanks to the most modern radiotherapeutic methods, it is now possible to protect healthy tissue from radiation damage in the best possible way.

Researchers at the Memorial Sloan-Kettering Cancer Center in New York were also looking into the risk of developing a second tumor after prostate cancer therapy1, investigating data from a total of 2,658 patients. Of these, 1,348 received radical removal of the prostate gland, 897 received external radiation and 413 received brachytherapy. The results show that second tumors occur relatively rarely: Ten years after treatment, for example, an average of 10 to 15 percent of patients were diagnosed with cancer again. Bladder or rectal tumors were the most common. The risk was 3 percent for patients undergoing surgery, 4 percent for patients receiving external radiation and only 2 percent for patients undergoing brachytherapy.

Accurate irradiation

Newer and much more targeted techniques such as brachytherapy mean that the majority of men nowadays hardly ever have their bowel and bladder in the radiation field,"emphasizes Dr. Derakhshani. "State-of-the-art computer technology and the use of imaging techniques make it possible for us to detect the target area with millimetre precision and irradiate it with pinpoint accuracy."

In brachytherapy, for example, the smallest radiation sources (seeds) are introduced directly into the tumor in contrast to external radiation. The seeds remain there for several months and emit high-dose radiation to the tumor tissue. This has the advantage that the tumour is destroyed without damaging surrounding healthy tissue such as the bladder, colon or sphincter,"said the urologist from Cologne.

In addition, it is often only decades later that radiation-related changes in the genetic material of healthy cells actually have an effect. However, the majority of all cancer patients undergoing irradiation are already in the second half of their lives at the time of their illness,"explains Dr. Derakhshani. This too must always be taken into account when comparing possible risks with the benefits of treatment.

Nevertheless, it is important to pay attention to secondary tumors during follow-up examinations,"emphasizes the Cologne urologist. Therefore, the bladder and rectum should be examined at regular intervals.

  1. Literature:
  2. Zelefsky MJ, Pei X, Teslova T, Kuk D, Magsanoc JM, Kollmeier M, Cox B, Zhang Z: Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific sur-vival outcomes according to the initial treatment intervention. BJU Int. 2012 Aug 13.

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