Clarifying Lung Cancer Risk Among Prostate Cancer Survivors
Principal Investigator
Name
Keith Sigel
Degrees
M.D., Ph.D., M.P.H.
Institution
Icahn School of Medicine at Mount Sinai
Position Title
Professor
Email
About this CDAS Project
Study
PLCO
(Learn more about this study)
Project ID
PLCO-1508
Initial CDAS Request Approval
Mar 25, 2024
Title
Clarifying Lung Cancer Risk Among Prostate Cancer Survivors
Summary
Prostate cancer (PC) is the most common cancer among men in the United States, and a leading cause of cancer-related death among men. Advances in detection and treatment have led to a rapidly growing population of PC survivors. According to the National Cancer Institute, there is a significant number of prostate cancer survivors living in the United States. This growing survivor population is now facing a major clinical issue with second cancers; lung cancer being a significant concern.
Adjuvant therapy, including surgery and radiation therapy, provided to PC patients is associated with reduced risk of local recurrence and provides a survival advantage. However, studies have found that radiotherapy (RT) for prostate cancer can increase the risk of developing secondary malignancies, including lung cancer, despite relatively lower rates of smoking compared to the general population. Despite this, current lung cancer screening guidelines, established for the general population, do not take prior cancer survivorship into account. Participants with a cancer diagnosis less than 5 years prior have been excluded from previous randomized trials. Yet, the effective lung cancer screening eligibility criteria among PC survivors may differ significantly from criteria for the general healthy population. While most patients with localized prostate cancer have a good prognosis and survival rate, the benefit/risk ratio from lung cancer screening is likely to differ substantially due to factors including competing risks of death (from cancer recurrence or non-prostate cancer comorbid conditions). Early harms of lung cancer screening and limited life expectancy due to these competing risks would complicate lung cancer screening regimen selection among PC survivors, leading to considerable practice variability. Currently, there is no randomized data or consistent observational results to guide surveillance imaging for lung cancer screening among PC survivors. Therefore, a better understanding of lung cancer incidence, adjusted for major lung cancer risk factors (including smoking, COPD status, and receipt of chest radiotherapy), is crucial for quantifying the benefits of lung cancer screening in this population.
The project aims to explore the joint effects of cigarette smoking and radiotherapy (RT; when data available) on lung cancer risk by using a multi-racial and ethnic PC survivor population and further modify the PLCOm2012 lung cancer risk model to aid in detecting a second primary lung cancer among PC survivors earlier in the course of the disease. Smoking patterns, smoking cessation, PC history, PC stage and grade, time elapsed since PC diagnosis date till the 2nd primary lung cancer diagnosis, and radiotherapy treatment will be incorporated for secondary lung cancer risk prediction and survival analysis. Additionally, we will estimate non-cancer mortality rates for PC survivors to understand competing risks of death for this group.
Adjuvant therapy, including surgery and radiation therapy, provided to PC patients is associated with reduced risk of local recurrence and provides a survival advantage. However, studies have found that radiotherapy (RT) for prostate cancer can increase the risk of developing secondary malignancies, including lung cancer, despite relatively lower rates of smoking compared to the general population. Despite this, current lung cancer screening guidelines, established for the general population, do not take prior cancer survivorship into account. Participants with a cancer diagnosis less than 5 years prior have been excluded from previous randomized trials. Yet, the effective lung cancer screening eligibility criteria among PC survivors may differ significantly from criteria for the general healthy population. While most patients with localized prostate cancer have a good prognosis and survival rate, the benefit/risk ratio from lung cancer screening is likely to differ substantially due to factors including competing risks of death (from cancer recurrence or non-prostate cancer comorbid conditions). Early harms of lung cancer screening and limited life expectancy due to these competing risks would complicate lung cancer screening regimen selection among PC survivors, leading to considerable practice variability. Currently, there is no randomized data or consistent observational results to guide surveillance imaging for lung cancer screening among PC survivors. Therefore, a better understanding of lung cancer incidence, adjusted for major lung cancer risk factors (including smoking, COPD status, and receipt of chest radiotherapy), is crucial for quantifying the benefits of lung cancer screening in this population.
The project aims to explore the joint effects of cigarette smoking and radiotherapy (RT; when data available) on lung cancer risk by using a multi-racial and ethnic PC survivor population and further modify the PLCOm2012 lung cancer risk model to aid in detecting a second primary lung cancer among PC survivors earlier in the course of the disease. Smoking patterns, smoking cessation, PC history, PC stage and grade, time elapsed since PC diagnosis date till the 2nd primary lung cancer diagnosis, and radiotherapy treatment will be incorporated for secondary lung cancer risk prediction and survival analysis. Additionally, we will estimate non-cancer mortality rates for PC survivors to understand competing risks of death for this group.
Aims
1. Using the PLCO lung cancer screening cohort to quantify the unadjusted and adjusted incidence rate of second primary lung cancer in prostate cancer survivors.
2. Recalculate the PLCOm2012 risk score, accounting for smoking history, PC history, PC stage, receipt of radiotherapy, and other previously established PLCOm2012 predictors.
3. Estimate the rate of non-lung cancer and non-prostate cancer mortality among prostate cancer survivors in the PLCO.
Collaborators
Juan Wisnivesky, Chung Yin Kong, Jenny Lin