title: Risk for developing myelodysplastic syndromes in prostate cancer patients definitively treated with radiation.
abstract: BACKGROUND
  Exposure to ionizing radiation has been linked to myelodysplastic syndromes (MDS); it is not clear whether therapeutic radiation doses used for prostate cancer pose an increased MDS risk.
  
  
  METHODS
  We performed a retrospective cohort study of prostate cancer patients diagnosed between 1986 and 2011 at Cleveland Clinic, comparing those who underwent definitive treatment with radical prostatectomy (RP) to radiotherapy either external beam radiotherapy (EBRT) or prostate interstitial brachytherapy (PI) and to population-based registries. Competing risk regression analyses were used to determine the cumulative risk of developing MDS. All statistical tests were two-sided.
  
  
  RESULTS
  Of 10924 patients, 5119 (47%) received radiation (n = 2183 [43%] in EBRT group and n = 2936 [57%] in PI group) and 5805 (53%) were treated with RP. Overall, 31 cases of MDS were observed, with age-adjusted incidence rates no higher than in population-based registries. In univariate analyses, advancing age (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.09 to 1.20; P < .001) and radiotherapy exposure (HR = 3.44; 95% CI = 1.41 to 8.37; P = .007) were statistically significantly associated with development of MDS. In multivariable analyses, although advanced age (HR = 1.13; 95% CI = 1.06 to 1.19; P < .001) remained statistically associated with MDS, radiation did not, although a small non-statistically significant trend existed for PI-treated patients. MDS rates were no higher than in population-based registries.
  
  
  CONCLUSIONS
  With relatively short follow-up, prostate cancer patients definitively treated with radiation did not appear to have a statistically increased risk of subsequent MDS.
authors.affiliation: Affiliations of authors: Leukemia Program (SM, RVT, AAA, YS, KP, SH, JPM, BJB, MK, MAS), Department of Radiation Oncology (CAR, JPC, MA-W), and Department of Solid Tumor Oncology (RD), Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC (EC); Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH (EAK).
authors.forename: Sudipto
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Ramon V
authors.initials: RV
authors.lastname: Tiu
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: Anjali A
authors.initials: AA
authors.lastname: Advani
authors.forename: Yogen
authors.initials: Y
authors.lastname: Saunthararajah
authors.forename: Katarina
authors.initials: K
authors.lastname: Paulic
authors.forename: Sean
authors.initials: S
authors.lastname: Hobson
authors.forename: Jaroslaw P
authors.initials: JP
authors.lastname: Maciejewski
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Robert
authors.initials: R
authors.lastname: Dreicer
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Mikkael A
authors.initials: MA
authors.lastname: Sekeres
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D001918:Brachytherapy / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen