title: Risk of prostate cancer mortality in men with a history of prior cancer.
abstract: To describe outcomes of patients with prostate cancer diagnosed after another malignancy and identify factors associated with prostate cancer death in this population, as little is known about the clinical significance of prostate cancer as a subsequent malignancy.
  
  
  
  We studied 18 225 men diagnosed with prostate cancer after another malignancy from 1973 to 2006. We compared demographic and clinical variables, and the proportion of death from prostate cancer vs prior malignancy with t-test and chi-squared analyses. Fine and Gray's regression was used to consider the effect of treatment on prostate cancer death. We then studied a second cohort of 88 013 men with prostate cancer as a first or second malignancy to describe current diagnostic and treatment patterns.
  
  
  
  One in seven men died from prostate cancer in our first cohort. More died from prostate cancer 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 cancer, kidney cancer, lung cancer, leukaemia and non-Hodgkin's lymphoma (all P < 0.001). Prostate cancer treatment was associated with a nearly 50% lower risk of death when high-grade or high-stage (adjusted hazard ratio 0.55, 95% confidence interval [CI] 0.47-0.64). Patients who died from prostate cancer had higher grade and stage disease, and received less treatment than patients who died from prior malignancy. The second cohort showed subsequent prostate cancer had more high-risk disease (36.3% vs 22.2%, P < 0.001) and less prostate cancer treatment (adjusted odds ratio 0.872, 95% CI 0.818-0.930) than primary prostate cancer.
  
  
  
  Prostate cancer remains a significant cause of mortality when diagnosed as a subsequent cancer. These results suggest prostate cancer treatment should be seriously considered in patients with prior malignancies, especially those with high-grade or locally advanced prostate cancer.
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Dinh
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Ziehr
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Muralidhar
authors.affiliation: Harvard T.H. Chan School for Public Health, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Vidya B
authors.initials: VB
authors.lastname: Viswanathan
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Nezolosky
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Orio
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Division of Urology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: prostate; prostatic neoplasm; second malignancy; survival; treatment