PTU - Polskie Towarzystwo Urologiczne
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The risk of induction of second cancer as a consequence of radiotherapy of prostate cancer
Article published in Urologia Polska 2005/58/4.


Piotr Milecki 1, Zbigniew Kwias 2
1 Zakład Radioterapii Wielkopolskiego Centrum Onkologii w Poznaniu
Kierownik zakładu: dr med. Grażyna Stryczyńska
2 Katedra Urologii Akademii Medycznej w Poznaniu
Kierownik katedry: prof. dr hab. Zbigniew Kwias


prostate, prostate cancer, radiotherapy, postradiation carcinogenesis, second primary cancer


Radiotherapy is one of the methods of radical treatment of prostate cancer and thus, the morbidity rate related to this method is an important issue. One of the most tragic late side effects of radiotherapy is possibility of induction of primary second cancer. Although, a lot of epidemiological analyses were carried out knowledge of many aspects of carcinogenesis is not appropriate. At present, generally the non-threshold model of carcinogenesis is accepted. According to this model, dose is in linear correlation to the biological effects. It is generally accepted that from practical point of view epidemiological data provided valuable data on the risk of expected second cancers. However, epidemiological estimation is associated with many biases related to the following factors: lack of assessment of genetic backgrounds, unknown of risk factors related to diet, or environment factors, smoking habits, etc. According to some authors radiotherapy for prostate cancer is associated with a small increase of risk of second tumors but among patients who survived longer period this risk is more pronounced. Another authors indicated that radiation therapy has been associated mainly with an increased risk of bladder carcinoma and colon cancer. General conclusion from these analyses indicated that the level of risk of induction of second cancer related to radiotherapy was low. Another aspect of carcinogenesis is evaluation of potential risk of induction of second cancers related to new and very sophisticated modern technique of radiotherapy as IMRT (intensity modulated radiotherapy), but further follow-up of large group of treated patients is needed in future for estimation this risk.
In conclusion, radiotherapy of prostate cancer is related to small increase of second tumors and due to high risk of death from prostate cancer the low risk related to induction of second cancer does not influence on general strategy of primary treatment.


  1. Syndikus I, Pickles T, Kostashuk et al: Postoperative radiotherapy for stage pT3 carcinoma of the prostate, improved local control. J Urol 1996, 155, 1983.
  2. Milecki P, Kwias Z, Skowronek J i in: Uzupełniająca i ratująca radioterapia u chorych z rakiem stercza po radykalnej prostatektomii. Pol Merkuriusz Lek 2004, 16, 495.
  3. Shipley WU, Thames HD, Sandler HM: Radiation therapy for clinically localized prostate cancer. A multi-institutional pooled analysis. JAMA 1999, 281, 1598.
  4. Hanks GE, Hanlon AL, Pinover WH et al: Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy. Cancer J Sci Am 1999, 5, 152.
  5. Hodgson D, Warde P, Gospodarowicz M: The management of locally advanced prostate cancer. Urol Oncol 1998, 4, 3-12.
  6. Ron E: Ionizing radiation and cancer risk, evidence from epidemiology. Radiat Res 1998, 150 (suppl), 30-41.
  7. Milecki P, Piotrowski T, Dymnicka M: The comparison of radiotherapy techniques for treatment of the prostate cancer, the three-field vs. the four-field. Neoplasma 2004, 51, 64-9.
  8. Milecki P, Stryczyńska G, Kwias Z et al: Tolerance of radiotherapy (3D CRT) and androgen ablation therapy for patients with prostate cancer. Rep Pract Oncol Radiother 2001, 6, 31.
  9. Milecki P, Szyfter K, Skowronek J: Ryzyko wyindukowania nowotworu wtórnego związane z radioterapią (3D CRT, IMRT) u chorych leczonych z powodu raka głowy i szyi. Otolaryngol Pol 2004, 58, 887-893.
  10. Martland HS: The occurrence of malignancy in radioactive persons, a general review of data gathered in the study of the radium dial painters, with special reference to the occurrence of osteogenic sarcoma and the interrelationship of certain blood diseases. Am J Cancer 1931, 15, 2435.
  11. Bongers V, Braakhuis BJ, Tobi H et al: The relation between cancer incidence among relatives and the occurrence of multiple primary carcinomas following head and neck cancer. Cancer Epidemiol Biomarkers Prev 1996, 5, 595-598.
  12. Lutz WK, Fekete T: Endogenous and exogenous factors in carcinogenesis, limits to cancer prevention. Inter Arch Occup Envir Health 1996, 68, 120-125.
  13. Kato H: Radiation-induced cancer and its modifying factor among A-bomb survivors. Princess Takamatsu Symp 1987, 18, 117-124.
  14. Shimizu Y, Mabuchi K, Preston DL et al: Mortality study of atomic-bomb survivors, implications for assessment of radiation accidents. World Health Stat Q. 1996, 49, 35-9. 40.
  15. Boice JD Jr: Carcinogenesis ? a synopsis of human experience with external exposure in medicine. Health Phys 1988, 55, 621-630.
  16. Boice JD: Cancer following medical irradiation. Cancer 1981, 47, 1081-1090.
  17. Little JB: Radiation carcinogenesis. Carcinogenesis 2000, 21, 397-404.
  18. Epstein R, Hanham R, Dale R: Radiotherapy-induced second cancers, are we doing enough to protect young patients? Eur J Cancer 1997, 33, 526-530.
  19. Cumberlin RL, Dritechilo A, Mossman KL: Carcinogenesis effects of scattered dose associated with radiation therapy. Int J Radiat Oncol Biol Phys 1989, 17, 623-629.
  20. Trott KR, Rosemann M: Molecular mechanisms of radiation carcinogenesis and the linear, non-threshold dose response model of radiation risk estimation. Radiat Environ Biophys 2000, 39, 79-87.
  21. Little JB: Genomic instability and radiation. J Radiol Prot 2003, 23, 173-181.
  22. Johnstone PA, Powell CR, Riffenburgh R et al: Second primary malignancies in T1-3N0 prostate cancer patients treated with radiation therapy with 10-year follow-up. J Urol 1998, 159, 946-949.
  23. Neugut AI, Habibul A, Robinson E, Ennis R: Bladder carcinoma and other second malignancies after radiotherapy for prostate carcinoma. Cancer 1997, 79, 1600-1604.
  24. Movsas B, Hanlon AL, Pinover W, Hanks GE: Is there an increased risk of second primaries following prostate irradiation? Int J Radiat Oncol Biol Phys 1998, 41, 251-255.
  25. Brenner DJ, Rochelle E, Curtis MA et al: Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer 2000, 88, 398-406.
  26. Pickles T, Phillips N: The risk of second malignancy in men with prostate cancer treated with or without radiation in British Columbia, 1984-2000. Radiother Oncol 2002: 65; 145-51.
  27. Hall EJ, Wuu CS: Radiation-induced second cancers, the impact of 3D CRT and IMRT. INT J Radiat Oncol Biol Phys 2003, 56, 83-88.
  28. Hall EJ, Martin SG, Amols H, Hei TK: Photoneutrons from medical linear accelerators ? radiobiological measurements and risk estimates. Int J Radiat Biol Phys 1995, 33, 225- 230.
  29. Malicki J, Kosicka G, Stryczyńska G, Wachowiak J: Cobalt 60 versus 15MeV photons during total body irradiation, doses in critical organs and complexicity of procedure. Ann Transplant 2001, 6, 18-22.


Piotr Milecki
Zakład Radioterapii Wielkopolskiego Centrum Onkologii
ul. Garbary 15
61-866 Poznań
tel. 061 8 850 533