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Risk of severe late toxicity after radiotherapy following radical prostatectomy: a nationwide study
Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.ORCID iD: 0000-0002-7061-7255
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
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2022 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 130, no 6, p. 799-808Article in journal (Refereed) Published
Abstract [en]

Objective: To estimate the long-term risks of severe late toxicities for radiation therapy (RT) following radical prostatectomy (RP) in an unselected nationwide cohort, as severe side-effects are rare but may occur years later. Patients and Methods: The study population comprised all men undergoing RP between 1997 and 2016 in the Prostate Cancer database Sweden (PCBaSe) (n = 40 962). By (1:2) matching, two cohorts were created: 2789 men exposed to postoperative RT and 5578 unexposed men with comparable age, comorbidities, and year of surgery. Cumulative incidences and rate ratios were calculated for the following outcomes: symptoms and interventions of the urinary or intestinal tract demanding inpatient care, secondary malignancies, and non-prostate cancer mortality. Results: The largest differences were seen for late toxicities affecting the urinary tract. The 10-year cumulative incidences among those exposed to postoperative RT vs the RP-only group were: 17.8% vs 10.5% for procedures of the urinary tract (difference 7.3%, 95% confidence interval [CI] 4.4 to 10.3; relative risk [RR] 1.74, 95% CI 1.47 to 2.05); 6.0% vs 1.2% for haematuria (difference 4.8%, 95% CI 3.1 to 6.5; RR 6.50, 95% CI 4.31 to 10.10); and 2.4% vs 1.1% for bladder cancer (difference 1.4%, 95% CI 0.4 to 2.3; RR 2.71, 95% CI 1.72 to 4.33). The groups were similar regarding intestinal toxicity, other secondary malignancies, and non-prostate cancer mortality. Adjustments for preoperative tumour risk factors did not importantly affect the rate ratios. Conclusion: Severe late toxicity after postoperative RT following RP predominately affects the bladder and can appear many years after RT.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022. Vol. 130, no 6, p. 799-808
Keywords [en]
mortality, prostate cancer, salvage radiation, secondary malignancy, side-effects
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-196102DOI: 10.1111/bju.15769ISI: 000798407900001PubMedID: 35523728Scopus ID: 2-s2.0-85130287887OAI: oai:DiVA.org:umu-196102DiVA, id: diva2:1672786
Available from: 2022-06-20 Created: 2022-06-20 Last updated: 2022-12-30Bibliographically approved

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Thellenberg-Karlsson, CamillaStattin, Pär

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