Evaluation and active treatment versus active surveillance of localized prostate cancer in renal transplant patients in the era of low and very low risk prostate cancer.

Current trends in renal transplantation such as improvement of allograft/ recipient survivals and expansion of organ transplantation eligibility criteria into older recipients are concomitant with increasingly detected low risk prostate cancer (PCa) in candidates for or recipients of renal transplantation. We review the evidence regarding PCa screening, diagnosis and management in renal transplant candidates and recipients. We focus on published reports regarding incidence and diagnosis of PCa in patients with End Stage Renal Disease (ESRD), pretransplant screening recommendations and recommendations regarding waiting time between treatment and active wait listing after the diagnosis of PCa in renal transplant candidates. In addition, we examine the natural history of PCa development after renal transplantation in the setting of standard immunosuppression.

An English-language literature review was done using search terms including prostate cancer, end-stage renal disease, renal transplantation, prostate cancer screening, prostate-specific antigen, prostate cancer treatment, active surveillance in various combinations.

PCa screening is still widely used for almost all patients with ESRD before and after transplantation. Active treatment of any PCa patients and a 5-year period of waiting time before transplantation can negatively affect the collective pool of participants and the overall survival of patients under dialysis. Several groups have proposed a shorter waiting time to kidney transplantation in patients with low risk PCa.

There are no standardized guidelines for screening and management of PCa before and after transplantation. In the era of low risk PCa, ESRD is a significant competing mortality risk factor. The role of active surveillance in these complex patients has yet to be well investigated. Further studies and nomograms are urged in order to integrate risk stratified screening and treatment protocols before and after renal transplantation.

The Journal of urology. 2019 Mar 05 [Epub ahead of print]

Alireza Aminsharifi, Ross Simon, Thomas J Polascik, Cary N Robertson, Debra L Sudan, Bradley H Collins, Judd W Moul

Divisions of Urology, Duke University Medical Center , Durham , NC., Abdominal Transplant Surgery, Department of Surgery, Duke University Medical Center , Durham , NC.