Prostate radiotherapy and the risk of secondary rectal cancer-a meta-analysis

Int J Colorectal Dis. 2022 Feb;37(2):437-447. doi: 10.1007/s00384-021-04075-6. Epub 2022 Jan 17.


Purpose: Radiotherapy is being used increasingly in the treatment of prostate cancer. However, ionising radiation may confer a small risk of a radiation-induced secondary malignancy. We aim to assess the risk of rectal cancer following pelvic radiotherapy for prostate cancer.

Methods: A search was conducted of the PubMed/MEDLINE, EMBASE and Web of Science databases identifying studies reporting on the risk of rectal cancer following prostatic radiotherapy. Studies must have included an appropriate control group of non-irradiated prostate cancer patients. A meta-analysis was performed to assess the risk of prostatic radiotherapy on subsequent rectal cancer diagnosis.

Results: In total, 4757 articles were screened with eight studies meeting the predetermined criteria. A total of 796,386 patients were included in this meta-analysis which showed an increased odds ratio (OR) for subsequent rectal cancer in prostate cancer patients treated with radiotherapy compared to those treated by non-radiotherapy means (OR 1.45, 1.07-1.97, p = 0.02).

Conclusion: These findings confirm that prostate radiotherapy significantly increases the risk of subsequent rectal cancer. This risk has implications for treatment selection, surveillance and patient counselling. However, it is crucial that this information is presented in a rational and comprehensible manner that does not disproportionately frighten or deter patients from what might be their most suitable treatment modality.

Keywords: Pelvic radiotherapy; Prostate cancer; Radiation-induced secondary malignancy (RISM); Radiotherapy (RT); Rectal cancer; Second primary malignancy (SPM).

Publication types

  • Meta-Analysis

MeSH terms

  • Humans
  • Incidence
  • Male
  • Neoplasms, Radiation-Induced*
  • Prostate
  • Prostatic Neoplasms* / etiology
  • Prostatic Neoplasms* / radiotherapy
  • Radiotherapy / adverse effects
  • Rectal Neoplasms* / etiology
  • Rectal Neoplasms* / radiotherapy