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Abstract
To assess etiological and clinical consequences of second primary cancers (SPCs) in prostate cancer (PC) patients, we followed newly diagnosed patients to identify men who were diagnosed with a SPC and recorded their causes of death. We used the Swedish Family‐Cancer Database to assess relative risks (RRs) and causes of death in SPCs until the year 2015 in patients with a PC diagnosis between 2001 and 2010. Among a total of 4.26 million men, 76 614 were diagnosed with PC at the median age of 71 years. Among them, 8659 (11.3%) received a subsequent diagnosis of SPC after a median follow‐up of 4 years. The most common SPCs were colorectal, skin, bladder, and lung cancers, melanoma, and non‐Hodgkin lymphoma. The ranking was almost identical with first cancers among elderly men in Sweden. The RR for SPCs in prostate‐specific antigen—detected PC was approximately equal to RR in other PC. Mortality patterns of PC patients were distinct depending on the presence or absence of SPC. Among patients with SPC, 47.8% died as a result of the corresponding SPC, followed by other causes (22.2%) and PC (18.1%). For patients without SPC, PC and non‐neoplastic causes almost matched each other as the main causes of death (48.5% and 47.8%). The results suggest that SPCs appear autonomous from primary PC and reflect incidence and mortality of first cancers in general. SPC was the most common cause of death in patients with SPC; close to half of the patients died due to SPC. For improved survival in PC patients, prevention and early detection of SPCs would be important, and the present results suggest that risk factors for SPC in PC are the same as those for first cancer in general.
Highlights
Survival rates of cancer have improved whereby the likelihood for second primary cancers (SPCs) has increased.[1,2] As prostate cancer (PC) is the most common cancer in males in developed countries, and as survival rates associated with PC are good, SPCs are diagnosed in many patients.[3]
Relative risks for SPCs compared to the risk of respective first cancers are shown in Table 2, which includes SPCs with at least 20 diagnoses but even the rare SPCs were included in the total
relative risks (RRs) for only three sites showed a significant difference (CIs were close to non-overlapping) between prostate-specific antigen (PSA) detected and other PC; lung cancer risk was lower and melanoma risk was higher in PSA—detected PC; TABLE 1 Demographical characteristics of males diagnosed with prostate cancer between 2001 and 2010 in Sweden
Summary
Survival rates of cancer have improved whereby the likelihood for second primary cancers (SPCs) has increased.[1,2] As prostate cancer (PC) is the most common cancer in males in developed countries, and as survival rates associated with PC are good, SPCs are diagnosed in many patients.[3]. In cancers that have good survival rates, such as Hodgkin lymphoma and testicular cancer, SPCs have become the main cause of death.[1,11,12] It can be assumed that higher-order multiple primaries (3rd, 4th, etc. primary cancers) increase along with SPCs occurrence of multiple primaries is often associated with genetic predisposition in the context of cancer syndromes.[1,11,13,14] The suspected iatrogenic cause of SPC in PC patients has been radiotherapy but the documented effects have mainly been limited to long follow-up times in organs of anatomic proximity, mainly the bladder and the rectum.[2,15,16]
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