Can you develop new prostate cancer after radiation?

From what I understand about radiation.... It destroys the cancer cells in the prostate and the healthy cells regenerate. Does that mean that you can develop new prostate cancer cells after RT?

Leah77 said...
From what I understand about radiation.... It destroys the cancer cells in the prostate and the healthy cells regenerate. Does that mean that you can develop new prostate cancer cells after RT?

Hi Leah,

The way you seem to be describing it is not quite right—technically the precise answer to your question is “no”—but you are definitely not off-track in the big picture...let me explain...

Primary radiation therapy does indeed ATTEMPT to “blast” and destroy the cancerous prostate with beams of intense energy, without “blasting” too much around it. But it is definitely a too-little/too-much balance. Two things can happen which can end up with the patient still having “cancer” afterwards...

In the first case, the RT may be insufficient for any one of several possible reasons to adequately and completely destroy all the prostate and the prostate cancer cells in the prostate, or in some cases the prostate cancer cells outside or around the prostate (the differences in these cases in the context of RT could be a whole other detailed discussion for another day). Of course, immediately after treatment the answer to whether all cancer cells were destroyed is unknown to all as there is nothing to actually “see” from the outside of the patient, and all the patient & doctor can do is monitor the blood levels of PSA produced by the “blasted” prostate into the patient's blood—looking for the PSA to go down and not come back up. If it stays down, we say "cured." If/when PSA does go back up, that’s what we call recurrent prostate cancer (or BCR, a biochemical recurrence), and a “failed” primary treatment. Eventually, usually months or years later, a secondary treatment is necessary for primary treatment failures, or at least recommended (and note that secondary PC treatments are more challenging/limited after primary radiation versus primary surgery...another different in-depth topic for a different day). Bottom line, the instance I have described is indeed “prostate cancer,” and more specifically it is “recurrent prostate cancer.” This RT treatment failure happens too frequently to be called “rare,” but is not necessarily “common.” Also, there is no particular “regeneration” of healthy cells which have been “blasted” (beyond normal cell reproduction taking place everywhere in your body) ... this being a part of your original question.

By contrast, a second type of “cancer” after RT which you might have also heard about is indeed “rare,” but definitely happens and there have been men here at HW/PC with this condition...a “secondary cancer” which is not prostate cancer but instead is caused by the primary radiation treatment itself. Bladder cancers, rectal cancers (most typically) and others have been traced in theory/likelihood to the “blasting” of the region around the prostate. (You've heard, no doubt, that too many x-rays to a particular part of the body can also cause cancer...what I am describing here is akin to the slow but repeated application of lower energy x-rays extrapolated to the rapid, intense application of high-energy radiation via RT treatments.) Biopsies of these "new" tumors reveal, as I indicated, a cell pattern very different than PC cells...so not PC, but a new, different cancer. Note that more common than full-blown rectal or bladder “secondary cancers” is the common occurrence of rectal or bladder “problems” from having those areas collaterally “blasted” (we call these "RT side effects")...unintended consequences of the prostate radiation treatment, some of which are short-term and resolve often with additional medications or treatments, others are long-term or "late-term," showing up months or even a couple years after treatment and often end up being "chronic."

So, in very direct response to your question, the first case I described here is indeed prostate cancer, but it is “recurrent” PC not “new” PC. The second case I illustrated is indeed a “new” cancer, but it is not prostate cancer.

Perhaps now you are getting a feel for the old saying that the prostate cancers “cures” are often worse than the disease itself.


It looks like you created two different threads yesterday, Leah...this one, and another completely different topic about "treatment regrets." The question about "regrets" is a very nuanced question and the broad question can mean really different things to different people based on their widely varying case situation. I'll try to post a reply to your other thread later today if I can find time. I just returned from a 3-day weekend to NC for my step-father's funeral, and actually have a pile of work in front of me today...sad!

Post Edited (Blackjack) : 3/4/2019 12:47:08 PM (GMT-7)

Thank YOU Blackjack very well written very understandable I NEED THAT. great day to all NEPOL

Indeed, Blackjack has presented an excellent description of two possible outcomes of prostate radiation.... and I will take this opportunity to reply to your earlier question about treatment choice and regrets.

When considering whether or not to go with primary radiation for my "high grade" (G8) prostate cancer, I spoke with two eighty year old men that I knew. One had primary radiation and not only had mild urinary incontinence, but also had bowel incontinence. Whether you want to call it incontinence or "urgency" depends on whether or not you are hearing from an actual RT "advocate". He has since passed away.

The other octogenarian had surgery followed by salvage radiation due to recurrent PSA. His PSA had remained undetectable for fifteen years and has zero continence issues. I saw him recently and has remarried and seems to be very happy.

As it turned out, my prostatectomy revealed adverse pathology that had not been detected by either MRI or biopsy. Just a heads up, all radiation is administered based upon external scans, and scans can be inaccurate.

I do not recall your husband's stats, but factors to consider in his case is whether he falls "below or above" 4+3, number of positive cores and whether his PSA was over 10 at time of biopsy. Many men here had lower grade Gleason scores and single digit PSA, and were able to get away with a single treatment modality, or combined radiation modalities along with ADT added. Not everyone was so fortunate, and I often cringe when I read them making treatment recommendations.

Personally I chose surgery, but required ADT and post-op radiation. It was always a possibility. So far it appears that my cancer has been eliminated, though one can never be certain. Consequently, I have also suffered many of the more severe side effects from each of those treatments. Some are more lucky than others. It is a risk we take. But I was unwilling to live with the possibility of persistent PSA and no way of knowing if the cancer had been eliminated. It was my choice and was appropriate for my particular case. And the factors affecting your condition will likely be totally different.

That scenario of finding prostate cancer months/years later in what remains of the "blasted" prostate is completely indistinguishable from what I described as recurrent prostate cancer...and if/when recurrence happens it is almost certainly caused by residual PC not mitigated by the primary RT...even if it may have "appeared" from monitoring to have been dormant (or below detectable measurement limits; or more likely varying up and down within a reasonable, naturally occurring range of values including a possible "bounce" or two) for months/years. The only reason I say "almost certainly" is because there is absolutely no way to know/trace it to one or the other...the characteristics would be identical. It would be labeled as "recurrent PC."

You should always ask your medical professionals these types of questions—to my knowledge, nobody here has an MD; and in fact you will get widely varying quality of responses from this site—but this site is a great place to do your best to sort wheat from chaff and ultimately get an understanding of the "big picture" (which busy docs don't always provide), and also to help "fine tune" your questions (as you just did).

Post Edited (Blackjack) : 3/4/2019 10:10:44 AM (GMT-7)

alephnull said...
Agree with everyone said, but might add.

The secondary cancers are extremely rare. This as told to me by my Rad Onc.

You may have a "feel good', stay positive spin, RO.

My several RO's, MO, and Gastro doc's all disagree, to some extent. Secondary cancers are unusual, have more probability of occurring as time passes, and are magnified with any other ailments (co-morbidites??) one may have. From my research, risk, in general, is about 1.5% over the first two years, and up to 7% over ten years. That ain't "extremely rare".

In my case, IMGT radiation reawakened (as anticipated) my long dormant ulcerative colitis, and dramatically increases my chance for a future, secondary cancer of the colon.

Excellent explanations BJ!!!

Leah, this entire disease has few, if any, certainties. Don't let your search for them wear you out. Good luck, again.

Leah, in the end--as we also said in the 'regrets' thread--do your research, collect as much information as you NEED (knowing that there are no sure things), look at the data on side effects (don't pay a lot of attention here--this is not a random group, but a very clearly self-selected group), and make a decision.

Once you do that, believe it or not, you'll relax. It's amazing how it works. Then, get it done, and accept the outcome--whatever it is.

Many cancers are successfully treated with radiation. I had two forms of radiation that actually nearly doubled the amount of radiation that can safely be delivered to the prostate by a single type of treatment, and the prostate bed and nodes were also treated.

if my cancer ever does return it was already systemic.

also when it comes to regret I would also take into consideration when the individual was treated.

alephnull said...
Garyi,
I hope not, he has been the most outright honest straight forward doc I've had.
Not my Uro, not my Onco, but yes my Rad Onc.

But if chances increase over time, then carp!!

Hope in your case, his prognosis is perfect!

From: https://hps.org/publicinformation/ate/q8592.html

Middle of first sentence.

“Overall, the risk of developing a second cancer among long-term survivors of a first malignancy is 14 percent, only a fraction of which is possibly attributable to radiation therapy, from New Malignancies among Cancer Survivors: SEER Cancer Registries, 1973-2000. Thus, while this risk is not negligible, it is certainly low enough that a patient should not forego potentially lifesaving therapy of an existing cancer because of it.”

Bottom line, there are no risk-free therapies. Some have immediate, short term risks, others have delayed, long term risks. It's all about the individual's assessment of their own risk tolerance. And all have the risk of not being curative--even for low risk diagnoses. At that point, all the statistics, and anecdotal evidence become almost meaningless. We all hope we will be in the large 'good' group, but at a certain point, we have to accept that we might not be, no matter how hard we try to swing it our way.