Cancer development after kidney transplant (KT) has become a major problem, and currently, it is one of the primary causes of death in this population. Urological cancers after KT such as prostate cancer (PCa) have also increased, partly due to the increasing age of recipients and prolonged survival. PCa is the second most commonly diagnosed cancer in men, accounting for 15% of all cancers. Managing localised PCa after KT remains challenging because of treating an immunosuppressed patient with a kidney graft in the pelvic cavity. Several papers reporting PCa treatment after KT have been published. Merging all the available data and summarising most important evidence could be useful for scientific community involved in this issue.
To systematically review all the available evidence in literature regarding the management of localised PCa after KT.
Computerised bibliographic search of Medline, Embase, and Cochrane databases was performed for all studies reporting outcomes of localised PCa diagnosed in KT patients undergoing curative treatments, including surgery, external beam radiotherapy (EBR) and brachytherapy.
In total, 41 studies included 319 patients with localised PCa after KT. Their mean age was 61.8 (range, 47-79) yr and mean time from KT to PCa was 122 (range, 2-336) mo. Mean prostate-specific antigen was 8.5 (range, 0.3-82), most frequent biopsy Gleason score was 3+3 (50.5%), 62.1% were cT1-cT2, and 56.1% belonged to low-intermediate D'Amico-risk groups. Surgery was performed in 82.1%. After mean follow-up of 33 (range, 1-240) mo, cancer-specific survival at 5 yr was 97.5%, 87.5%, and 94.4% after surgery, EBR, and brachytherapy, respectively.
Radical prostatectomy is the preferred treatment of localised PCa after KT. Overall oncological outcomes do not seem to be worse than general population when performed in referral centres. Other curative treatments such as EBR or brachytherapy were less frequently used; however, brachytherapy showed promising results in a small number of patients. Further better-quality studies should help to clarify the optimal method of managing localised PCa after KT.
Localised PCa after KT seems to have similar oncological outcomes after curative treatments than in general population, with surgery being the most common option for treatment.
European urology focus. 2018 Jun 16 [Epub ahead of print]
Vital Hevia, Romain Boissier, Óscar Rodríguez-Faba, Claire Fraser-Taylor, Rhana Hassan-Zakri, Enrique Lledo, Heinz Regele, Klemens Buddde, Arnaldo Figueiredo, Jonathon Olsburgh, Alberto Breda
Urology and Kidney Transplant Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain. Electronic address: ., Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Aix-Marseille University, France., Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain., Department of Urology and Transplant, St Georges NHS Trust Hospitals, London, UK., Department of Transplant and Urology, Guy's & St Thomas' NHS Trust Hospitals, London, UK., Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Department of Nephrology, Charité Medical University Berlin, Berlin, Germany., Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal.