secondary cancer risk not so much an issue after radiotherapy

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Regular Member

Date Joined Sep 2010
Total Posts : 309
   Posted 2/11/2011 9:59 PM (GMT -6)   
An abstract dated February 10, 2011 on the Urotoday website may interest some of you. I know the issue of secondary cancers has been debated on the forum, and this abstract is encouraging for those of us who have chosen RT as a primary therapy, and I think it may be to all who have undergone SRT as well.

I thought I'd post a link, but if you can't access it, the gist is this: Analysis of the risk of secondary cancers after radiotherapy is compared to the risk following RRP and little difference is found. Here is a snippet:

"To clarify such risk in the modern era, this study generated a unique dataset by matching prostate cancer patients treated with RT to those treated with surgery according to age and follow-up time. This method reduced the impact of selection bias and accounted for the two major confounding factors for the development of second malignancies. The resulting matched-pair data were then stratified into four subsets according to radiotherapy techniques. For the subset with older conventional external beam RT (2DRT), the second malignancy risks were increased for multiple organ-sites as compared to the surgical patients. However, replacing part of the 2DRT treatment with a brachytherapy boost reduced the second malignancy risk to a level comparable to its surgical control. Brachytherapy, by delivering radiation from radioactive sources within the prostate and taking advantage of the inverse square law of physics, would have significantly reduced the dose being delivered to the normal tissues outside of prostate. Furthermore, the more conformal modern external beam RT (3DCRT and/or IMRT) also reduced the risk to a level comparable to the surgical control. These more conformal techniques would have allowed a reduction of RT field as compared to 2DRT, which would translate to a significant reduction of normal tissue being irradiated directly as well as possible scattering radiation to more distant tissues. Therefore, this study provided clinical evidence to support theoretical hypothesis based on dosimetric modeling."

The point was made that modern radiotherapy has dramatically changed over the last two decades. I have no commentary other than to say that I hope I posted the link correctly!


Veteran Member

Date Joined Feb 2010
Total Posts : 3988
   Posted 2/11/2011 10:15 PM (GMT -6)   
"Are you crazy? The fall will probably kill you."
-- Butch Cassidy

age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 2/12/2011 3:28 AM (GMT -6)   
Even ready the quote makes me glad I'm being treated now raether than 20 years go.
And this might make the link easier to get to:


Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 2/12/2011 7:50 AM (GMT -6)   
F8 great quote from Paul Neuman in Butch Cassidy and the Sundance Kid....I know about every stinkin' line from the movie, since I like humor my memory bank filed them all. I'm a colorful person!!!!

Radiation equipment, strategies and planning, power and delivery have made huge strides in 20+ years. Early radiation machines were known for collateral damage, the 'Box' machine was especially primative compared to todays equipment and likely not found any more, except maybe in foreign countries with no options or money for real equipment of today. Targeting methods improved and nuainces as to your breathing and thus the moving targets concept..have computerized controls to allow for this in real time and corrected delivery to the prostate or other areas.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 2/12/2011 10:15 AM (GMT -6)   
Interesting information. The problem is the way things are stated. For instance there was a recent article that headlined "Hormone treatment of PCa increases odds of colon cancer by 40%" (Or something like that) Here is the problem with that statement. It is alarmist and does not state the odds of getting PCa without HT. (nor did the article) If the odds of a person developing colon cancer are only 5% for the general population then odds after HT are only 7%. Still a relatively low number and only slightly worse than the norm. But then the head line would not have been as eye catching.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 2/12/2011 8:23 PM (GMT -6)   
The real problem is that there are so many myths about radiation that have been disproven but are still commonly recited, mostly by doctors and even by radiologists. You hear them on this board all the time.
1, You are too young to have radiation because of the danger of secondary cancers. No evidence to support this, and secondary cancers are just as common after surgery.
2. Your cancer is too agressive to be treated by seeds. Published results shows Brachy with intermediate and high risk patients are equal or superior to surgery.
3. Your prostate is too big for seeds. Many doctors treat large prostates with no problems and similar results.
4. You don't get a 2nd chance with radiation, but if surgery fails you have other options. Total BS, there are many options after radiation.
5. You can't have Brachy or radiation after a TURP. Selected patients have no issues.
6. Seeds are not effective for transition zone tumors (my surgeon told me this). They are extremely effective, much more than surgery which is extremely difficult for anterior tumors.
5. It doesn't matter because side affects are similar after three years and side affects from radiation keep getting worse. Where you are in two years is most likely where you will end up. It rarely gets worse. Quality of life studies indicate Brachy patients are much more satisfied with their QOL long term.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/12/2011 8:53 PM (GMT -6)   
John, you know that I personally don't have a bias against seeding, was actually my original first choice for treatment. But the radiation doctors I talk to used your #2 and your #3 as being reasons I shouldn't be "seeded". They had a financial interest in me going that route, so why would they blow off a chance for a customer? You are almost making it look like there isn't any criteria anymore for seeding, all the normal sources show that there are criteria levels for seeding.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Veteran Member

Date Joined Sep 2008
Total Posts : 744
   Posted 2/12/2011 9:00 PM (GMT -6)   
Does proton radiation induce a chance for secondary cancers?

Veteran Member

Date Joined Jul 2010
Total Posts : 3891
   Posted 2/14/2011 12:47 AM (GMT -6)   
ALL radiation increases the chance of cancer developing...Radiation used to treat cancer is no different..That's why radiation therapists and x-ray technicians go to such great lengths to avoid accidental or unnecessary exposure..The early researchers in radioactive materials suffered horrendous injuries and increased cancer rates..

Proton radiation damages all the tissue it strikes, be it cancerous or healthy..The advantage is it strikes less tissue outside the target area so less healthy tissue is damaged.. There is no exit path with protons..

It's a risk / benefit thing...When you are fighting a potentially terminal illness and the treatment (radiation) ads a 3% higher risk of developing a radiation caused cancer later on, most people are willing to accept that risk..Nobody forces anybody to have radiation treatment or any other treatment..

With RT, the primary risk is the direct damage to healthy tissue not secondary cancers..When my SRT was being planned, a dose of 80 Grey was talked about..By using the latest equipment and trying as hard as he could, my radiation oncologist thought this was possible and safe. But he cut his plan back to 72 Gy when the risk-benefit equation could not be worked out and 80Gy was deemed too dangerous to try..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 2/14/2011 12:48 PM (GMT -6)   
What I'm saying is that your doctors were dead wrong when they told you that.
Too aggressive: " Published data by Dattoli and Grimm for high risk patients show Brachy superior to surgical results at the leading institutions.
Too Big: " By extending the lithotomy position, problems with pubic arch interference can be circumvented". Also glands can be reduced 50% with three months of Casodex.
This is exactly my issue. Most doctors including radiologists treat all sorts of cancers and they just are not up to date on PC. They remember something they heard 10 years ago and may have been true then, but is not true with today's technology. Doctors like Dattoli and Grimm who only treat prostate cancer and nothing else routinely treat aggressive PC and large prostates with excellent results.
There was a post on "seedpods" just last week from a patient who was told his prostate was too large and couldn't be treated because of pubic arch interference. A Brachy doctor responded to him and said in over 1500 procedures he had never had any problems treating large prostates; the patient just has to be put into a different position than the standard position.
I don't think there is a conspiricy or anything, I just think that unless PC is your only field you cannot possibly keep up with all the newest data and are working with ideas that you learned in Med school 20 years ago that may not be true today.
The above study on secondary cancers and the one published a few weeks ago on the NewProstate Cancer Infolink show secondary cancers post radation at the same level as post surgery. Yet some posters are still talking about the dangers of secondary cancers even though the danger is equal to dieing immediately on the operating table due to complications and no one ever mentions this risk.
We see some of the same myths about hormone therapy. Once a myth gets established it is very hard to kill it.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.
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