Risk of secondary cancer with radiation is small...but...

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 7:02 PM (GMT -6)   
This is an interesting article on radiation therapy and secondary cancers. The radiation oncologist that sent it to me stated that the overall risk is 1 in 1000 patients will develop secondary cancer from being treated with radiation. He also stated that the risks before seven years was almost non-existent.

www.medicalnewstoday.com/articles/220297.php

There was a catch...The article states the following:

"The researchers estimated that 8% (about 3300) of these second cancers could be related to radiotherapy treatment for the first cancer. More than half of these were in breast and prostate cancer survivors."

It's just a report but it put's some telling light on things. Does this mean that a RO should be telling us these risks in better detail.

I think so...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 3/30/2011 7:08:22 PM (GMT-6)


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 3/30/2011 7:05 PM (GMT -6)   
mINE Mentioned it
 
Mel

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 3/30/2011 7:08 PM (GMT -6)   
Mine explained it to me also. Squid.
*Age 63, PSA July 2009 .66; Biopsy: 2 of 12 cores positive, Gleason 3 + 5
*open Surgery 10/22/09
*Post Surgery Biopsy Gleason 4 + 3; 2 positive margins
*03/11/10 - Bladder neck surgery for stricture
*PSA - 30 day/.07, 90 day/<.1, 180 day/.21
*07/27/10 - IGRT done - 39 zaps, 70 gys
*10/07/10 - 90 day post IGRT PSA <.1.
*01/20/11 - 180 day post IGRT PSA <.1.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 7:13 PM (GMT -6)   
Mine mentioned it too. But he didn't mention how frequent, that it has higher prevalence in prostate cancer patients, nor that "gestation" would be about seven years for occurrence rates to start showing themselves. What did yours say?

Tony

Julietinthewoods
Regular Member


Date Joined Sep 2010
Total Posts : 309
   Posted 3/30/2011 7:25 PM (GMT -6)   
My husband's radiation oncologist was very frank about it. He didn't say anything to minimize the risk. These statistics are actually encouraging to me.

We were well aware that there were risks with every single treatment option. Right now I am coping with the news that my very favorite uncle has bone mets from what had appeared to be successful treatment for lung cancer five years ago. I think that the recurrence of the original cancer, or treatment failure, is just something all cancer patients face. It is a bit like jumping hurdles. You get over one and start watching for the next one. It is often coming, in one form or another. The possibility of a secondary cancer looms just like the chance of treatment failure and progression of the original cancer, neither option necessarily worse than the other.

Or maybe I'm just blue today.

Juliet

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 7:29 PM (GMT -6)   
Juliet,
I am very sorry for the news of your uncle. He'll be in my prayers.

I worry about the younger guys that elect to have radiation. I am one of them so I start sweating bullets when I turn 50? I certainly hope not to see this happen. It would be a shame to acquire a dangerous cancer in exchange for treating one that might not have killed me?

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 3/30/2011 7:46 PM (GMT -6)   
I think I was told 5-10 years regarding a possible secondary cancer
 
Mel

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 8:14 PM (GMT -6)   
Mel did he mention what the occurrence rates was for treating prostate cancer?

Tony

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 8:22 PM (GMT -6)   
The gentleman that sent the post did mention that the benefits of radiation therapy outweigh the risks. And that's obvious. But I wonder what the stats are when you vary the demographics of the patients that do acquire secondary cancers. For example I had adjuvant IMRT at the age of 44. What are the 20 year secondary cancer rates for me?

Because of scant study data, I'll have to wait and see.

Tony

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 8:30 PM (GMT -6)   
I'm talking to myself here...lol

I should read the paper...

www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70061-4/abstract

Findings
647,672 cancer patients who were 5-year survivors were followed up for a mean 12 years (SD 4·5, range 5—34); 60 271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded 1, and varied from 1·08 (95% CI 0·79—1·46) after cancers of the eye and orbit to 1·43 (1·13—1·84) after cancer of the testes. In general, the RR was highest for organs that typically received greater than 5 Gy, decreased with increasing age at diagnosis, and increased with time since diagnosis. We estimated a total of 3266 (2862—3670) excess second solid cancers that could be related to radiotherapy, that is 8% (7—9) of the total in all radiotherapy patients (≥1 year survivors) and five excess cancers per 1000 patients treated with radiotherapy by 15 years after diagnosis.

Tony

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 243
   Posted 3/30/2011 8:57 PM (GMT -6)   
Hi,

My Radiation oncologist talked to me about it.
He had me get a Colonoscopy. Found 3 polyps non cancerous.
Cuts down the odds of colon cancer.
Gerry
age 72 diag 68 Oct 2006 G8 T2b psa 11.7
4 of 8 cores 20% 30% 60% 100%
rrp Dec 2006 G9 4+5 m+ sv+ ece after 6 weeks psa 0.6 second opinion Dana-Farber pT3b 4+4 + T5 = G9
3/2007 ADT2 6 months lupron + casodex
4/2007 SRt 35 sessions to lymph nodes and prostrate. Psa <0.1 from June 2007 to March 2010
Psa 6/10 0.3 9/10 0.6 12/10 2.5 :(
Dana- Farber Phase 2 trial Avastin ADT2
3/11 psa 0.02

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 8:59 PM (GMT -6)   
Sounds like good advice, Gerry.
I wonder if somebody like me should have greater frequency of such diagnostics...at an earlier age.

Tony

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 3/30/2011 9:00 PM (GMT -6)   
Another report on Secondary Primary Cancers, from the New Prostate Cancer Infolink:
The results of this analysis are as follows:

•Overall risk for SPCs — regardless of follow-up time — was not significantly higher in the radiation therapy patients than in the surgery patients (hazard ratio [HR] = 1.14).
•At > 5 years of follow-up there was a significant risk for SPCs in the radiation therapy patients compared to the surgery patients (HR = 1.86).
•At >10 years of follow-up, the risk for SPCs in the radiation therapy patients compared to the surgery patients was further increased (HR = 4.94).
•When broken down by type of radiation, the overall relative risk for SPCs compared to surgery was
◦HR =1.76 for 2D-EBRT
◦HR =0.81 for 3D-EBRT/IMRT
◦HR = 0.53 for BT
◦HR = 0.83 for 2D-EBRT + BT
• The types of SPC occurring most commonly among the patients receiving primary radiation therapy were bladder cancers, lymphoproliferative cancers (e.g., non-Hodgkin’s disease), and sarcomas.
It appears from these data that the only type of primary radiation therapy that increased overall risk for SPCs in this patient population (compared to surgery) was 2D-EBRT — classical radiation therapy that is rarely used today as first-line therapy for localized disease. However, the abstract to the paper does not provide a breakdown of either year of initial therapy or length of follow-up by type of radiation, so if (for example) 10-year follow-up data was only available for the 2D-EBRT patients, the results could be skewed in a manner that would perhaps be misleading. However, the authors clearly conclude that, “Radiation-related SPC risk varies depending on the [radiation therapy] technique and may be reduced by using BT, [BT +
JT
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.

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 243
   Posted 3/30/2011 9:04 PM (GMT -6)   
Hi Tony

He advises all his prostate patients to have one.
Doctor said everything was good see you in 5 years.

One more thing being proactive.:)

That was my first one.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/30/2011 9:09 PM (GMT -6)   
I wonder what risk I am at with this subject, having 70 gys of rt in 2000 and 72 gys in 2009, and not counting all the endless xrays and scans since
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 2/11 1.24
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 9/10,

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 9:15 PM (GMT -6)   
Gerry if you remember, being proactive was my theme when I set out. I don't see any reasons to change it now.

@John,
I saw that one, too. Mike's post was a much smaller cohort however we don't know the exact number in this new study that were prostate cancer specific treatments. But looking at the data of both you can see that the prostate cancer specific hazard ratio in the InfoLink article was 4.94 at ten years and the Lancet abstract was 5 in 1,000 in 15 years. That would appear that in all forms of radiation therapy for prostate cancer there is a much higher incidence rate than with other cancers.

Of course it's too tempting to make the comparison.

Tony

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/30/2011 10:32 PM (GMT -6)   
I wonder if my first RT experience triggered my PC, is that even a possibility. My PC dx was 8 years after my first RT. What do you think? None known in my family ever.
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 2/11 1.24
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 9/10,

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 243
   Posted 3/30/2011 11:30 PM (GMT -6)   
Hi,

I guess thats one of the questions that we will never know the answer too.
Other than asbestoses exposure and or smoking.

I've worked with some heavy duty chemicals and lived in some undeveloped countries with terrible sanitation and safety issues with handling toxic chemicals.

But I only went to the hospital to visit, never a patient.

I guess it is what it is and try to do the best you can with it.

Best wishes
Gerry
age 72 diag 68 Oct 2006 G8 T2b psa 11.7
4 of 8 cores 20% 30% 60% 100%
rrp Dec 2006 G9 4+5 m+ sv+ ece after 6 weeks psa 0.6 second opinion Dana-Farber pT3b 4+4 + T5 = G9
3/2007 ADT2 6 months lupron + casodex
4/2007 SRt 35 sessions to lymph nodes and prostrate. Psa <0.1 from June 2007 to March 2010
Psa 6/10 0.3 9/10 0.6 12/10 2.5 :(
Dana- Farber Phase 2 trial Avastin ADT2
3/11 psa 0.02

Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 3/30/2011 11:42 PM (GMT -6)   
Hi,
I think that as radiotherapy advances and the radiotherapy beams are triggered at more angles (or perhaps even continuous angles in the future) to decrease destruction of healthy tissue we will see larger increases of secondary cancers as larger portion of the body is subjected to radiation, albeit at lower doses.

It is one reason why I believe proton therapy could have lower chances of secondary cancers, as the beams is stationary and transverse in relation to the body, and works in the brag peak system. However, there is suppose to be intensity modulated proton beam in the works.

Post Edited (Squirm) : 3/30/2011 10:46:21 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/30/2011 11:45 PM (GMT -6)   
Gerry,
Congrats on this months PSA reading...

Yea I think you're right. If you want to go the radiation rout the benefits outweigh the risks. It doesn't matter if for primary, adjuvant, or salvage approaches. The best is what I am hoping for...

Tony

Devasted1
Regular Member


Date Joined Feb 2011
Total Posts : 494
   Posted 3/31/2011 12:03 AM (GMT -6)   
Thanks Tony. I am pretty far down the path for a open cut RP and not pursue radiation, and the article sheds light on the unexpected consequences of IMRT, Seeds, etc. Thank you for sharing it with me. I am in Round 2 of the Provenge study and have surgery set for April 27th.
Born July'`1959
DRE Positive
Biopsy 7 out of 12 Positive
Gleason 4+4 both sides
PSA Jan 2011 5.5
Diag. February 15, 2011
Participant in Provenge Study
Surgery Scheduled for Aprtil 25

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/31/2011 12:12 AM (GMT -6)   
Devasted1,
Keep us updated on your progress. Will this Provenge study allow you to get post surgery radiation without exclusion? I'm not sure I would hesitate if the pathology would suggest it is not a bad strategy. Even with the risks, the therapy can be highly beneficial. You add a new element with Provenge. It will be very good to see the results of the study.

Good luck!

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/31/2011 8:28 AM (GMT -6)   
tony, was hoping you would make a stab at my situation with your radiation risk question considering i have been through major radiation twice.
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 2/11 1.24
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 9/10,

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/31/2011 9:43 AM (GMT -6)   
David,
I concur with Gerry's post to you. We can't ever say that your previous experience with radiation caused your second cancer. It would be presumptuous to do so. But I couldn't rule it out either. Family history does not need to be present to get prostate cancer. I think that radiation is a secondary cancer risk, albeit a small risk, that because of the male anatomy that places a very small prostate in an area that is very tight with other organs, that we have higher risks with radiation than other cancers treated with radiation have. This long term data supports that to some degree. I think that what this means is that whomever is going to live with the radiation treated prostate the longest, the younger men, should take this into deeper consideration than say someone in their 60's would. Our study data goes to 10 years and to 15 years based on two studies in this thread. And after 10 years the risk for secondary cancers from radiation therapy go up exponentially.

I did not hear that from my RO. I learned it along the way but I probably still thought that my present situation was worth the risk after surgery. It will take a few cancer free years to verify that I still feel that way.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4278
   Posted 3/31/2011 10:11 AM (GMT -6)   
I guess it's always interesting to talk about the rare issues that can occur on the edges of the curve.  But, in the interest of balance, and lest any new members see this thread and get scared away from radiation as a primary treatment...let me point out that Dr. Scholz quotes that the risk of dying during prostate cancer surgery is 1 in 200.  So, your chance of dying during prostate cancer surgery is 5 times greater than your chance of getting a secondary cancer from radiation treatment.
 
Personally, I think new patients should focus on the big three...cure, continence and sexual function....and not worry too much about the rare SE's.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643
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