The risk of second malignancies following prostate cancer radiotherapy in the era of conformal radiotherapy - a statement of the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO) - Short communication

Sep 21, 2026

Uploaded by Aurelia

This short communication discusses current evidence on second primary cancers after definitive radiotherapy for prostate cancer, drawing on six retrospective studies (2021–2024) using large data repositories while often not addressing all confounders such as smoking or pre-existing comorbidities. Patients treated with curative radiotherapy show an increased second primary cancer risk (0.7–1%) versus surgery up to 25 years. Evidence indicates that intensity modulated radiotherapy and highly conformal techniques may not elevate second primary cancer probability compared with conformal 3D planning or radical prostatectomy, and future studies should better control technique and confounders.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Keywords

Introduction

Definition and clinical significance of radiation-induced second primary cancers

Methodology

Literature search criteria and inclusion rules

Results

Included studies and qualitative review overview

Strahlentherapie und Onkologie (2025) 201:4–10 [https://doi.org/10.1007/s00066-024-02288-6](https://doi.org/10.1007/s00066-024-02288-6) SHORT COMMUNICATION The risk of second malignancies following prostate cancer radiotherapy in the era of conformal radiotherapy: a statement of the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO) C. Zamboglou1,2 · D. M. Aebersold3 · C. Albrecht4 · D. Boehmer5 · U. Ganswindt6 · N.-S. Schmidt-Hegemann7 · S. Hoecht8 · T. Hölscher9 · S. A. Koerber10,11 · A.-C. Mueller12 · P. Niehoff13 · J. C. Peeken14 · M. Pinkawa15 · B. Polat16 · S. K. B. Spohn2 · F. Wolf17 · D. Zips5 · T. Wiegel18 Received: 17 July 2024 / Accepted: 24 July 2024 / Published online: 28 August 2024 © The Author(s) 2024 Abstract A signiﬁcant number of prostate cancer patients are long-term survivors after primary deﬁnitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021–2024 using large data repositories not accounting for all possible confounding factors, such as smoking or pre-existing comorbidities. Overall, prostate cancer patients treated with curative radiotherapy have an increased risk (0.7–1%) of the development of second primary cancers compared to patients treated with surgery up to 25 years after treatment. However, current evidence suggests that the implementation of intensity modulated radiation therapy is not increasing the risk of second primary cancers compared to conformal 3D-planned radiotherapy. Furthermore, increasing evidence indicates that highly conformal radiotherapy techniques may not increase the probability of second primary cancers compared to radical prostatectomy. Consequently, future studies should consider the radiotherapy technique and other confounding factors to provide a more accurate estimation of the occurrence of second primary cancers. Keywords Prostate cancer · Radiotherapy · Second primary cancer Introduction Prostate cancer (PCa) is the most common malignancy in males in the Western world, and radiation therapy (RT) is a standard treatment option for localized or locally advanced disease. The PROTECT trial reported long-term survival rates of 15 years after RT for patients with mainly lowrisk PCa [1] . The FLAME study reported 5-year progression-free survival of 85–92% for intermediate- and highrisk patients after RT [2] . Similar biochemical failure-free survival rates of 81–95% were reported by the POP-RT trial, which included only patients with high-risk disease [3] . These results suggest that a signiﬁcant number of PCa pa- 􀀂 C. Zamboglou [constantinos.zamboglou@uniklinik-freiburg.de](constantinos.zamboglou@uniklinik-freiburg.de) Extended author information available on the last page of the article tients are long-term survivors after primary deﬁnitive therapy. Consequently, the long-term side effects after RT for local or regional disease in PCa have gained interest in recent years. The development of a radiation-induced second primary cancer (SPC) is one of the most serious long-term consequences for these patients. A SPC is generally deﬁned as radiation induced if it is diagnosed after a latency period (usually 3–5 years or more) following RT, occurs within or adjacent to the radiation ﬁeld, is a different histological type from the original cancer, and the second tumour was not evident at the time of RT [4, 5] . Importantly, the SPC is the most common cause of death in patients with SPC [6] . In 2014, the PROBATE group of the GEC-ESTRO performed a systematic review of the risk of second malignancies after RT for PCa [7] . The authors identiﬁed 19 registry publications, 21 institutional series, and 7 other studies and concluded that the risk of SPC appears small, K in the range of 1 to 220–290 over all durations of follo

FAQs

What is the main focus of this statement regarding second malignancies after prostate cancer radiotherapy?

It summarizes current evidence on the risk of second primary cancers following prostate cancer radiotherapy and compares findings across treatment modalities and radiation techniques.

How is a radiation-induced second primary cancer (SPC) generally defined in the document?

An SPC is considered radiation induced if diagnosed after a latency period (usually 3–5 years or more), occurring within or adjacent to the radiation field, having a different histology than the original cancer, and not evident at the time of radiotherapy.

Does intensity modulated radiotherapy (IMRT) appear to increase second primary cancer risk compared with conformal 3D radiotherapy?

Current evidence discussed in the document suggests that implementing IMRT is not increasing the risk of second primary cancers compared with conformal 3D-planned radiotherapy.

Sep 21, 2026

Uploaded by Aurelia