Long-Term Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy

J Urol. 2024 Jul;212(1):63-73. doi: 10.1097/JU.0000000000003965. Epub 2024 Apr 11.


Purpose: Second malignancy is a rare but potentially lethal event after prostate brachytherapy, but data remain scarce on its long-term risk. The objective of this study is to estimate the number of pelvic second malignancies following brachytherapy compared to radical prostatectomy (RP).

Materials and methods: We retrospectively reviewed patients treated with low-dose 125I brachytherapy and RP in British Columbia from 1999 to 2010. Kaplan-Meier estimates for pelvic (bladder and rectum), invasive pelvic, any second malignancy, and death from any second malignancy were assessed. Cox multivariable analyses were performed adjusting for initial treatment type, age, post-RP adjuvant/salvage external beam radiation therapy status, and smoking history.

Results: Two thousand three hundred seventy-eight brachytherapy and 9089 RP patients were included. Median age was 66 years (interquartile range [IQR] 61-71) and 63 years (IQR 58-67), respectively. Median follow-up time to event or censured was 14 years (IQR 11.5-17.3). The Kaplan-Meier estimates for pelvic second malignancy at 15 and 20 years were 6.4% and 9.8%, respectively, after brachytherapy, and 3.2% and 4.2% after RP. Time to any second malignancy and time to death from any second malignancy were not significantly different (P > .05). On Cox multivariable analysis, brachytherapy, compared to surgery, was an independent factor for pelvic (hazard ratio [HR] 1.81 [95% CI 1.45-2.26], P < .001) and invasive pelvic second malignancy (HR 2.13 [95% CI 1.61-2.83], P < .001). Increased age and smoking were also associated with higher estimates of events (P < .001).

Conclusions: After adjustment for age, post-RP adjuvant/salvage external beam radiation therapy status, and smoking status, numerically higher long-term HRs of pelvic and invasive pelvic second malignancy in patients treated with brachytherapy compared to RP were noted.

Keywords: brachytherapy; neoplasms; prostatectomy; prostatic neoplasms; radiation-induced; radiotherapy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Brachytherapy* / adverse effects
  • Brachytherapy* / methods
  • Humans
  • Male
  • Middle Aged
  • Neoplasms, Second Primary* / epidemiology
  • Neoplasms, Second Primary* / etiology
  • Prostatectomy* / methods
  • Prostatic Neoplasms* / radiotherapy
  • Prostatic Neoplasms* / surgery
  • Radiotherapy Dosage
  • Retrospective Studies
  • Time Factors