Analysis of overall survival in patients with second primary malignancies following with the first diagnosis of nonmetastatic prostate cancer: A study utilizing the Surveillance, Epidemiology, and End Results database

Abstract

Background: Survival in patients with prostate cancer (PCa) is now significantly prolonged. However, the incidence of secondary primary malignancies (SPMs) has increased during the treatment for PCa, which adversely affects patient survival. This study explored the factors influencing the overall survival (OS) of SPM in patients with nonmetastatic PCa and the impact of SPM with different histologic types on OS.

Materials and methods: We evaluated the clinical data of patients diagnosed with PCa of T1N0M0 to T4N0M0 between 2010 and 2015 from the Surveillance, Epidemiology, and End Results database. The patients were divided into 2 groups: with or without SPM. The key risk factors affecting OS were analyzed using Cox regression analysis. To mitigate the influence of other confounding factors, we performed propensity score matching in a 1:1 ratio. The Kaplan-Meier method was used to assess the impact of SPM on OS across different histological types.

Results: In total, 208,984 patients with nonmetastatic PCa were enrolled, including 16,573 and 192, 411 patients in the SPM and non-SPM groups, respectively. Age (p < 0.05), chemotherapy (p = 0.010), presence of SPM (p < 0.05), Gleason score of the biopsy specimens (p < 0.05), and prostate-specific antigen levels (p < 0.05) were identified as independent risk factors for OS. Conversely, race (p < 0.05), radical prostatectomy (p < 0.05), and radiotherapy (p < 0.05) were independent protective factors of OS. The 5-year OS rate was worse in the SPM group than in the non-SPM group (72.9% vs. 91.2%, p < 0.05). Patients with SPM of the pulmonary and bronchial types have the worst long-term prognosis, whereas those with SPM of cutaneous melanoma have the best prognosis.

Conclusions: During the management of patients with PCa, we must extend our attention beyond potential PCa recurrence and metastasis to the possibility of SPM, which compromises patient survival.

Keywords

Second primary malignancies / Prostate cancer / Kaplan-Meier curve / Prognosis

Acknowledgments

The authors gratefully acknowledge the Surveillance, Epidemiology, and End Results Program for providing the data used in this study. The interpretation and reporting of these data are the sole responsibility of the authors.

Statement of ethics

This study was exempt from ethical approval and patient informed consent requirements because patient information in the SEER database is publicly available and anonymous. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

YN is a member of Editorial Board of Current Urology and confirms no involvement in any stage of this article's review process, ensuring unbiased editorial decision making. The other authors declare no conflicts of interest.

Funding source

This work was supported by the Beijing Key Clinical Specialty Development Project (20240930), the National Key Clinical Specialty Development Project (20250829), and the National Natural Science Foundation of China (grant number 82170783).

Author contributions

GZ: Conceptualization, methodology, writing-original draft, supervision, project administration;RW: Software, formal analysis, data curation, visualization, writing-review and editing; TX: Investigation, resources, validation, writing-review and editing;ZL: Resources, validation, writing-review and editing;ZL: Formal analysis, data curation, writing-review and editing;YN: Supervision, funding acquisition, writing-review and editing.

Data availability

The data that support the findings of this study are available from the Surveillance, Epidemiology, and End Results (SEER) program (https://seer.cancer.gov/), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission from the SEER program.

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