Second cancers in radically treated Norwegian prostate cancer patients

Figures & data

Table 1. Patient, tumor, and treatment characteristics.

	EBRT	RP	RT after RP	HDR-BT	Not radically treated	Total cohort
No. of patients	11,048	10,760	2162	622	33,102	57,694
Mean age at PC diagnosis, y (range)	66 (41,87)	62 (39,91)	62 (39,77)	66 (45,83)	73 (37,101)	70 (37,101)
Age at diagnosis, no.
<55 y	422 (3.8)	1156 (10.8)	236 (10.9)	21 (3.4)	745 (2.2)	2580 (4.5)
55–64 y	3523 (31.9)	5447 (50.6)	1156 (53.4)	243 (39.0)	4854 (14.7)	15,223 (26.4)
65–74 y	6102 (55.2)	4071 (37.8)	762 (35.3)	317 (51.0)	11,459 (34.6)	22,711 (39.4)
75–84 y	999 (9.1)	80 (0.7)	8 (0.4)	41 (6.6)	13,100 (39.6)	14,228 (24.6)
≥85 y	2 (0.02)	6 (0.01)	0	0	2944 (8.9)	2952 (5.1)
Period of diagnosis, no.
1997–2003	2729 (24.7)	1307 (12.1)	388(18.0)	16 (2.6)	12,330 (37.2)	17,942 (29.1)
2004–2009	4843 (43.8)	3647 (33.9)	1012(46.8)	424 (68.2)	10,754 (32.5)	21,478 (35.8)
2010–2014	3476 (31.5)	5806 (54.0)	762 (35.2)	182 (29.2)	10,018 (30.3)	19,704 (35.1)
Stage PC diagnosis, no.
Localized	6363 (57.6)	7274 (67.6)	977 (45.2)	419 (67.4)	15,548 (47.0)	30,581 (53.0)
Regional met.	1950 (17.7)	2329 (21.7)	916 (42.4)	116 (18.6)	3451 (10.4)	8762 (15.2)
Distant met.	147 (1.3)	36 (0.3)	7 (0.3)	6 (1.0)	4690 (14.2)	4886 (8.5)
Unknown	2588 (23.4)	1121 (10.4)	262 (12.1)	81 (13.0)	9413 (28.4)	13,465 (23.3)
Follow up, median, y (range)	7.75 (0.003–20.42)	6.25 (0.003–20.42)	8.17 (0.09–20.42)	8.05 (0.25–20.09)	4.33 (0.003–20.42)	5.50 (0.003–20.42)
Follow up, person, y	87,494	77,310	15,087	4809	173,935	358,635

Data in parentheses are percentages.

EBRT: external beam radiotherapy; RP: radical prostatectomy; RT after RP: radiotherapy after prostatectomy; HDR-BT: high-dose-rate brachytherapy; no.: number; PC: prostate cancer; y: year.

Follow-up from 1 year after PC diagnosis.

Table 2. SIRs for all SCs and selected subtypes in 57,694 PC patients.

	SIR	95% CI
Total cohort (No. = 57,694)	1.02	1.00–1.05
Radically treated patients (No. = 24,592)	1.04	1.00–1.08
RP (No. = 10,760)	0.93	0.87–0.99
EBRT (No. = 11,048)	1.12	1.07–1.17
Colon cancer (total cohort)	1.11	1.04–1.18
Radically treated patients	1.10	1.00–1.22
RP	1.23	1.05–1.44
EBRT	1.06	0.93–1.21
Rectal cancer (total cohort)	1.17	1.07–1.28
Radically treated patients	1.22	1.07–1.40
RP	0.95	0.74–1.23
EBRT	1.38	1.16–1.64
Urinary bladder cancer (total cohort)	1.16	1.08–1.24
Radically treated patients	1.31	1.18–1.44
RP	0.96	0.79–1.17
EBRT	1.49	1.31–1.69
Lung cancer (total cohort)	0.91	0.85–0.97
Radically treated patients	0.85	0.77–0.94
RP	0.63	0.52–0.77
EBRT	1.01	0.90–1.14
Sarcoma (total cohort)	1.07	0.71–1.60
Radically treated patients	1.16	0.64–2.09
RP	0.56	0.14–2.24
EBRT	1.61	0.81–3.23

SIR: standardized incidence ratio; CI: confidence interval; No.: number of patients; RP: radical prostatectomy; EBRT: external beam radiotherapy.

Figure 1. Risk of SC, all sites, in 21 808 PC patients treated with RP or EBRT. RP: radical prostatectomy; EBRT: external beam radiotherapy.

Table 3. Multivariable analysis for the risk of all SC and selected sites in patients treated with EBRT, RT after RP and HDR-BT compared to RP treated patients.

	SHR (95% CI)*	p-Value
ALL SC
RP	1
EBRT	1.37 (1.26–1.50)	<.001
RT after RP	1.27 (1.09–1.50)	.002
HDR-BT	1.13 (0.89–1.44)	.305
Colon cancer
RP	1
EBRT	1.09 (0.87–1.37)	.441
RT after RP	0.95 (0.62–1.44)	.797
HDR-BT	0.68 (0.32–1.45)	.320
Rectal cancer
RP	1
EBRT	1.47 (1.06–2.06)	.023
RT after RP	1.13 (0.61–2.08)	.697
HDR-BT	0.95 (0.34–2.63)	.921
Bladder Cancer
RP	1
EBRT	1.95 (1.51–2.53)	<.001
RT after RP	2.32 (1.57–3.42)	<.001
HDR-BT	2.36 (1.34–4.15)	.003
Lung cancer
RP	1
EBRT	1.91 (1.49–2.45)	<.001
RT after RP	1.22 (0.76–1.95)	.408
HDR-BT	1.78 (0.98–3.23)	.058
Sarcoma
RP	1
EBRT	2.92 (0.57–14.97)	.200
RT after RP	3.84 (0.35–42.42)	.273
HDR-BT	NA**

EBRT: external beam radiotherapy; RT: radiotherapy; HDR-BT: high-dose-rate brachytherapy; RP: radical prostatectomy; SHR: subdistribution hazard ratio; CI: confidence interval.

*Adjusted for age at diagnosis, stage at diagnosis, and period of diagnosis.

NA** it was not possible to estimate SHR for sarcoma in HDR-BT treated patients due to lack of diseased in this group.

Figure 2. Risk of SC, selected sites, in RP and EBRT treated patients. RP: radical prostatectomy; EBRT: external beam radiotherapy.