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There are many treatment options available for persons with prostate cancer. Radiation therapy and surgery, for example, are thought to be treatments of similar effectiveness for persons with localized prostate cancer (cancer that has not spread to other parts of the body). Now, researchers report that radiation therapy, compared with surgery, is associated with a small increased risk for developing second cancers 5 to 15 years after treatment. This slight increased risk may not play a significant role in treatment choices for older men, but may be a consideration for younger men with prostate cancer.

Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. Treatment for prostate cancer depends on the stage of disease (extent of disease at the time of diagnosis), and may include surgery, radiation therapy, hormone therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. Researchers at the Center for Radiological Research at Columbia University and the Radiation Epidemiology Branch of the National Cancer Institute recently compared the results of 51,584 persons who received radiation therapy with those of 70,539 persons who underwent surgery without radiation therapy for prostate cancer.

The findings of this comparison showed that radiation therapy in persons with prostate cancer was associated with a 6% increase in the development of second cancers (solid, non-blood cancers) compared to treatment with surgery alone. The longer the survival time, the greater was the overall increased risk of developing a second cancer. After 5 years of survival, the increased risk jumped to 15%; after 10 years, to 34%. Although these increased risks are large, analysis showed the absolute (definite) risk of developing a second cancer to be quite small, with the estimated risk of a radiation-related second cancer being 1 in 290 for all years, 1 in 125 after 5 years, and 1 in 70 after more than 10 years after treatment.

The researchers concluded that these estimated risks of radiation-associated second cancers are small, and will not be a factor for most persons with prostate cancer. However, recently radiation has been used more frequently to treat early-stage prostate cancer in younger persons, thus significantly increasing their survival time. The findings of this report may be a consideration for these younger men with prostate cancer. (Cancer, Vol 88, No 2, pp 398-406, 2000)

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