Health Report:

Radiation Treatment of Prostate Cancer & Risk of Second Cancers

Sexual Content on TV & Teen Pregnancy Risk

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Photo of Dr. Wascher

Last Updated:  11/2/2008

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


Exposure to high doses of ionizing radiation, whether from a nuclear explosion or from radiation therapy for cancer, has long been known to increase the risk of cancer formation.  A growing body of clinical data is helping to further develop our understanding of secondary radiation-induced cancers. 

Much of our current understanding about radiation-induced cancer is based upon long-term observation of the Japanese survivors of the World War II atomic bombings in Hiroshima and Nagasaki.  In particular, an increased incidence of leukemia, myeloma, and cancers of the thyroid, breast, lung, stomach, esophagus, ovary and bladder has been identified in atomic bomb survivors who were close to ground zero.

Following the catastrophic failure of the Chernobyl nuclear reactor in Ukraine, in 1986, an excess of leukemia and thyroid cancer among workers who were involved in the clean-up of the reactor’s contaminated debris has already been documented.

More recently, several studies have reported upon the incidence of secondary cancers in adults who were treated with radiation therapy for lymphoma during childhood and adolescence.  An increased incidence of cancers of the lung and the female breast has been confirmed among patients who previously underwent extended-field chest irradiation (also known as mantle radiation therapy) for Hodgkin’s Lymphoma, and these secondary cancers typically occur 15 to 20 years following treatment.  Rare cancers of the bone and cartilage, called sarcomas, have also been associated with prior radiation therapy treatments.  Now, a new research study suggests that certain forms of prostate cancer radiation therapy may also be linked to an increased risk of subsequent radiation-induced secondary cancers.

Currently, there are several different treatment approaches available for prostate cancer therapy.  Surgery can be performed to completely remove the prostate gland (prostatectomy) when the tumor is still confined to the prostate.  Implants of radioactive seeds, placed within the prostate gland (brachytherapy), can also be used to destroy cancer within the prostate.  External beam irradiation is another form of radiation therapy, but unlike brachytherapy, external beam irradiation is delivered by a machine that concentrates radiation onto the prostate gland from a source external to the body.  Although great progress has been made in fine-tuning the delivery of radiation to the prostate gland with both brachytherapy and external beam irradiation, there is, inevitably, some “collateral damage” that occurs to the organs and tissues that surround the prostate, as it is impossible to confine 100 percent of the delivered radiation dose to the prostate gland alone.

A new study, in the Journal of Urology, evaluated the cancer treatment records of more than 240,000 men who had previously been treated for prostate cancer with prostatectomy, brachytherapy, external beam radiotherapy or a combination of brachytherapy and external beam radiotherapy between 1988 and 2003.  The data for this study was collected from the massive Surveillance, Epidemiology and End Results (SEER) national cancer database, which is maintained by the National Cancer Institute.  This study was conducted by researchers from Columbia University and the Mount Sinai Medical Center. 

In this study, the authors compared the incidence of subsequent cases of cancers of the bladder and rectum occurring in these 243,082 men.  The men who underwent prostatectomy alone, and who did not receive any radiation therapy, essentially served as the “control group” for this study.

An almost insignificant increase in the risk of bladder cancer was seen in the men who underwent brachytherapy alone.  However, there was a more pronounced and statistically significant increase in the risk of both bladder cancer and rectal cancer observed among the men who received either external beam radiotherapy alone or combined brachytherapy and external beam radiotherapy.  Compared to the men who underwent prostatectomy alone, external beam irradiation was associated with an 88 percent increase in the relative risk of developing bladder cancer, and a 26 percent increase in the relative risk of developing rectal cancer.  Among those men who received both brachytherapy and external beam radiotherapy, the relative risk of developing bladder cancer was 85 percent higher than what was observed in the men who underwent prostatectomy alone, while the relative risk of developing rectal cancer was 21 percent higher.  (It should be noted that “relative risk” is a measure of the difference in risk between two patient treatment populations, and is not the same as the “absolute risk” of developing a particular disease.)

In this retrospective study, which involves a relatively short duration of clinical follow-up, external beam irradiation for prostate cancer (either administered alone or in combination with brachytherapy) was associated with a significant increase in the risk of developing subsequent cancers of the bladder and rectum. 

Since most studies of radiation-induced secondary cancers have shown an average biological lag time of 15 to 20 years between radiation therapy and the diagnosis of secondary malignancies, the findings of this study may actually underestimate the long-term risks of secondary bladder and rectal cancers in men who have previously received external beam radiotherapy as treatment for their prostate cancers.  At the same time, however, recent and continuing improvements in the accuracy of radiation therapy delivery have significantly reduced the “innocent bystander” effect, whereby clinically significant doses of radiation are absorbed by the organs that surround the prostate gland (namely, the bladder and the rectum).  As a final note, all retrospective studies that are based upon prospectively collected data, such as this study, are subject to potential biases, including the “completeness” of the clinical data that is present within large databases such as the SEER database.  However, based upon a large body of clinical literature on this topic, the findings of this particular study are not at all surprising, or unexpected.

All patients who are planning to undergo therapy for prostate cancer should first talk with their oncologists about the unique risks and benefits associated with each potential treatment option before choosing the best and most appropriate form of therapy.



Although the effects of violent and sexual content on television, or on video games, on adolescents and young adults is the subject of considerable debate, there are multiple recent studies that appear to substantiate the concerns of many parents who wrestle with these issues.  For example, several clinical research studies have recently found that children who frequently play video games with violent themes are more likely to engage in aggressive or antisocial behavior at school and at home. 

In view of the enormous impact of teen pregnancy on individuals, families and society, many parents and family advocates have viewed with alarm the increasingly unfiltered sexual content present in both movies and television shows.  A new Rand Corporation study, just published in the journal Pediatrics, has concluded that there may well be a significant link between exposure to television shows with sexual content or themes, on the one hand, and the likelihood of pregnancy prior to age 20.  This study was funded by the National Institute of Child Health and Human Development, which is part of the National Institute of Health (NIH).

In this study, data from prospective surveys of teens were analyzed over a 3-year period.  A total of 1,762 adolescents between the ages of 12 and 17 anonymously completed surveys regarding their sexual experiences and their television viewing habits, and the same group of teens then completed the same survey one year later.  The incidence of teen pregnancy in this group of adolescents was monitored for a period of 3 years.

Sexual content in television shows measured by the surveys included: (1) sexually-oriented behaviors such as kissing, intimate touching, and implied or depicted intercourse; and (2) discussions about sexual plans or desires, or about sexual behavior that had already occurred, or “expert advice” about sexually-related topics.

The results of this study demonstrated a linear association between heavy exposure to sexual content on television and the initiation of intercourse and other sexual behaviors during adolescence.  The teens who anonymously admitted to watching the greatest number of sexually-themed television shows were 2 times as likely to initiate sexual intercourse within the following year as were the teens who watched the least amount of sexual content on TV.  In terms of age-related sexual behavior, 12 year-olds who watched the greatest number of television shows with sexual themes engaged in sexual activities at a level comparable to 14- and 15-year-old teens who watched the least number of shows with sexual content.  An especially interesting finding of this study was that television shows that featured only discussions about sexual activities were still associated with an increased likelihood of engaging in intercourse, and in teenage pregnancies, among adolescents viewing such shows. 

Other adolescent behaviors linked with the early initiation of intercourse included: older age, hanging out with older friends, achieving lower grades at school, sensation-seeking behaviors, and rule-breaking behaviors (e.g., skipping classes). 

On the other hand, behaviors most associated with a lower likelihood of intercourse during adolescence included: having parents who monitored their teens’ behavior, having more educated parents, having parents who disapproved of teenage sexual activity, and living with both parents (please note that the greatest deterrents to adolescents engaging in intercourse, based upon the results of this prospective clinical study, involved parent-related factors…).

In this study, an early age at initiation of sexual activity (including intercourse), and the incidence of teen pregnancy, were found to strongly correlate with the extent to which television shows with sexual content (including mere discussions about sexual activities and behaviors) were viewed by teens.  Conversely, minimizing viewing exposures to such television programming, and being supervised by two parents who disapproved of adolescent sexual behavior, was associated with the lowest rates of teen sexual activity and teen pregnancy.

Many parents will respond to the findings of this research study with something along the lines of, “No, duh….”  However, this is the first prospectively conducted research study to confirm what many of us parents have long believed.  My advice is to stay connected with your teens, and stay involved with their lives, even when they demand that you do otherwise.

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center


Send your feedback to Dr. Wascher at rwascher@doctorwascher.net

Links to Other Health & Wellness Sites

Copyright 2008.  Robert A. Wascher, MD, FACS.  All rights reserved.

Dr. Wascher's Archives:

10-26-2008:  Smoking & Quality of Life

10-19-2008:  Agent Orange & Prostate Cancer

10-12-2008:  Pomegranate Juice & Prostate Cancer

10-5-2008:  Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008:  Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008:  Does TylenolŪ (Acetaminophen) Cause Asthma?

9-14-208:   Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008:  Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008:  Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008:   Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

 Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008:  Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008:  Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008:  Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008:  Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008:  Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008:  Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008:  Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008:  Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008:  Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008:  Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008:  Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008:  Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008:  BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008:  Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008:  Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008:  Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008:  Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008:  Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008:  Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity 

3-2-2008:  Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008:  Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008:  Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008:  Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for  Down's Syndrome?

2-3-2008:  Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008:  Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008:  Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008:  Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008:  Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007:  Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007:  Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007:   Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality 

12-11-2007:  Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:  Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer 


Top of Page