OBJECTIVES: To describe outcomes of patients with prostate cancer (PCa) diagnosed after another malignancy and identify factors associated with PCa death in this population, as little is known about the clinical significance of PCa as a subsequent malignancy.
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PATIENTS AND METHODS: We studied 18,225 men diagnosed with PCa after another malignancy from 1973 to 2006. We compared demographic and clinical variables and proportion of death from PCa versus prior malignancy with T-test and chi-squared analyses. Fine and Gray's regression was used to consider the effect of treatment on PCa death. We then studied a second cohort of 88,013 men with PCa as a first or second malignancy to describe current diagnostic and treatment patterns.
RESULTS: One in seven men died from PCa in our first cohort. More died from PCa following colorectal cancer (16.8 vs. 13.7%), melanoma (13.4 vs. 7.56%), and oral cancer (19.1 vs. 4.04%), but fewer following bladder, kidney, lung, leukemia and non-Hodgkin's lymphoma (all p< 0.001). PCa treatment was associated with a nearly 50% lower-risk of death when high-grade or high-stage PCa (AHR 0.55; 0.47-0.64). Patients who died from PCa had higher-grade and stage disease and received less treatment than patients who died of prior malignancy. The second cohort showed subsequent PCa had more high-risk disease (36.3 vs. 22.2%,p< 0.001) and less PCa treatment (AOR 0.872, 0.818-0.930) than primary PCa.
CONCLUSIONS: PCa remains a significant cause of mortality when diagnosed as a subsequent cancer. These results suggest PCa treatment should be seriously considered in patients with prior malignancies, especially those with high-grade or locally-advanced PCa.
Dinh KT, Mahal BA, Ziehr DR, Muralidhar V, Chen YW, Viswanathan VB, Nezolosky MD, Beard CJ, Choueiri TK, Martin NE, Orio PF, Sweeney CJ, Trinh QD, Nguyen PL. Are you the author?
Harvard Medical School, Boston, MA.
Reference: BJU Int. 2015 Apr 4. Epub ahead of print.