Advertisement

Secondary bladder cancer during long-term follow-up after iodine-125 permanent seed implantation for localized prostate cancer

      Abstract

      Introduction

      Brachytherapy for prostate cancer treatment may induce secondary bladder cancer during long-term follow-ups. This study reviews the risk and tumor characteristics of secondary bladder cancer after brachytherapy.

      Methods

      This single-institution retrospective study included 1162 patients treated with low-dose-rate permanent seed implantation brachytherapy with iodine-125, with or without external beam radiation therapy, for localized prostate cancer. We calculated and compared the rates of secondary bladder cancer among patients treated with brachytherapy and radical prostatectomy (n = 218) before and after a propensity score-matching analysis. Possible risk factors for secondary bladder cancer, such as patient age and external beam radiation therapy administration, were analyzed.

      Results

      Of 1162 patients with a median follow-up period of 11.4 (range: 0.7–15.5) years, 26 presented with urothelial carcinomas and 1 with adenocarcinoma at a median of 8.9 (range: 2.9–14.0) years after brachytherapy, although the incidence rates of secondary bladder cancer after brachytherapy were not significantly different from those after radical prostatectomy. No significant risk factors for secondary bladder cancer were identified. The initial symptoms of secondary bladder cancer were gross hematuria (74%) and microscopic hematuria with positive urine cytology (15%). Among 26 cases of secondary urothelial carcinoma, 54% were high-grade and 46% were invasive. After brachytherapy, invasive urothelial carcinoma occurred later than noninvasive urothelial carcinoma (p = 0.01).

      Conclusions

      Considering the aggressive malignancy of secondary bladder cancer, cystoscopy and urine cytology should be performed for further investigation of the causes of gross or microscopic hematuria and rule out secondary bladder cancer in cases followed longer than 3 years after brachytherapy.

      Keywords

      Abbreviations:

      BCA (Bladder cancer), BED (Biological effective dose), CT (Computed tomography), D90 (Minimal dose delivered to 90% of the prostate volume), EBRT (External beam radiation therapy), LDR (Low-dose-rate permanent seed implantation brachytherapy with iodine-125), LUTS (lower urinary tract symptoms), NCCN (National Comprehensive Cancer Network), PCA (Prostate cancer), PSA (Prostate-specific antigen), RP (Radical prostatectomy), TUR (Transurethral resection of bladder tumor), UC (Urothelial carcinoma)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dracham CB
        • Shankar A
        • Madan R.
        Radiation induced secondary malignancies: a review article.
        Radiat Oncol J. 2018; 36: 85-94
        • Keehn A
        • Ludmir E
        • Taylor J
        • Rabbani F.
        Incidence of bladder cancer after radiation for prostate cancer as a function of time and radiation modality.
        World J Urol. 2017; 35: 713-720
        • Mazzone E
        • Mistretta FA
        • Knipper S
        • et al.
        Long-term incidence of secondary bladder and rectal cancer in patients treated with brachytherapy for localized prostate cancer: a large-scale population-based analysis.
        BJU Int. 2019; 124: 1006-1013
        • Bhojani N
        • Capitanio U
        • Suardi N
        • et al.
        The rate of secondary malignancies after radical prostatectomy versus external beam radiation therapy for localized prostate cancer: a population-based study on 17,845 patients.
        Int J Radiat Oncol Biol Phys. 2010; 76: 342-348
        • Singh AK
        • Mashtare TL
        • McCloskey SA
        • et al.
        Increasing age and treatment modality are predictors for subsequent diagnosis of bladder cancer following prostate cancer diagnosis.
        Int J Radiat Oncol Biol Phys. 2010; 78: 1086-1094
        • Nieder AM
        • Porter MP
        • Soloway MS.
        Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study.
        J Urol. 2008; 180 (discussion 2009–2010): 2005-2009
        • Moschini M
        • Zaffuto E
        • Karakiewicz PI
        • et al.
        External beam radiotherapy increases the risk of bladder cancer when compared with radical prostatectomy in patients affected by prostate cancer: a population-based analysis.
        Eur Urol. 2019; 75: 319-328
        • Neugut AI
        • Ahsan H
        • Robinson E
        • Ennis RD.
        Bladder carcinoma and other second malignancies after radiotherapy for prostate carcinoma.
        Cancer. 1997; 79: 1600-1604
        • Brenner DJ
        • Curtis RE
        • Hall EJ
        • Ron E
        Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery.
        Cancer. 2000; 88: 398-406
        • Moon K
        • Stukenborg GJ
        • Keim J
        • et al.
        Cancer incidence after localized therapy for prostate cancer.
        Cancer. 2006; 107: 991-998
        • Bostrom PJ
        • Soloway MS.
        Secondary cancer after radiotherapy for prostate cancer: should we be more aware of the risk?.
        Eur Urol. 2007; 52: 973-982
        • Hinnen KA
        • Schaapveld M
        • van Vulpen M
        • et al.
        Prostate brachytherapy and second primary cancer risk: a competitive risk analysis.
        J Clin Oncol. 2011; 29: 4510-4515
        • Romanenko A
        • Morimura K
        • Wei M
        • et al.
        DNA damage repair in bladder urothelium after the Chernobyl accident in Ukraine.
        J Urol. 2002; 168: 973-977
        • Romanenko A
        • Morimura K
        • Wanibuchi H
        • et al.
        Urinary bladder lesions induced by persistent chronic low-dose ionizing radiation.
        Cancer Sci. 2003; 94: 328-333
        • Romanenko A
        • Kakehashi A
        • Morimura K
        • et al.
        Urinary bladder carcinogenesis induced by chronic exposure to persistent low-dose ionizing radiation after Chernobyl accident.
        Carcinogenesis. 2009; 30: 1821-1831
        • Stock RG
        • Stone NN
        • Cesaretti JA
        • Rosenstein BS.
        Biologically effective dose values for prostate brachytherapy: effects on PSA failure and post- treatment biopsy results.
        Int J Radiat Oncol Biol Phys. 2006; 64: 527-533
        • Au S
        • Keyes M
        • Black P
        • et al.
        Clinical and pathological characteristics of bladder cancer in post brachytherapy patients.
        Pathol Res Pract. 2020; 216152822
        • Sandhu JS
        • Vickers AJ
        • Bochner B
        • et al.
        Clinical characteristics of bladder cancer in patients previously treated with radiation for prostate cancer.
        BJU Int. 2006; 98: 59-62
        • Murray L
        • Henry A
        • Hoskin P
        • et al.
        Second primary cancers after radiation for prostate cancer: A systematic review of the clinical data and impact of treatment technique.
        Radiother Oncol. 2014; 110: 213-228
        • Burger M
        • Catto JW
        • Dalbagni G
        • et al.
        Epidemiology and risk factors of urothelial bladder cancer.
        Eur Urol. 2013; 63: 234-241
        • Masaoka H
        • Matsuo K
        • Ito H
        • et al.
        Cigarette smoking and bladder cancer risk: an evaluation based on a systematic review of epidemiologic evidence in the Japanese population.
        Jpn J Clin Oncol. 2016; 46: 273-283
        • Hinotsu S
        • Akaza H
        • Miki T
        • et al.
        Bladder cancer develops 6 years earlier in current smokers: analysis of bladder cancer registry data collected by the cancer registration committee of the Japanese Urological Association.
        Int J Urol. 2009; 16: 64-69
        • Leapman MS
        • Hall SJ
        • Stone NN
        • Stock RG.
        Hematuria after prostate brachytherapy.
        BJU Int. 2013; 111: E319-E324
        • Leapman MS
        • Stock RG
        • Stone NN
        • Hall SJ.
        Findings at cystoscopy performed for cause after prostate brachytherapy.
        Urology. 2014; 83: 1350-1355