Prostate Cancer in Men with Treated Advanced Heart Failure: Should we keep Screening?

To evaluate the outcomes of men diagnosed with prostate cancer (PCa) following implanted treatments for advanced heart failure. Given the increasingly favorable 10-year life expectancy, MedStar Washington Hospital Center (MWHC) screens heart transplant (HT) candidates for PCa and other malignancies prior to intervention.

Men aged 18-90 with normal pre-transplant PSA who underwent LVAD/HT at MWHC from 2007-2018 were identified. Serum PSA, PCa diagnosis, and treatment were captured and analyzed. Survival was analyzed using Kaplan-Meier curves.

Data was available for 34 patients. Median age was 53 [IQR=51-58]. Median follow-up was 77mo (95% CI=40-87mo). Six men had post-implant elevated PSA (5.3; SD=8.5) and 4 were diagnosed with PCa. Median age of PCa diagnosis was 59 [IQR=58.5-62). As of 2018, 31 of the 34 patients were living, and none died from PCa. Five-year survival was 96% in those without PCa and 100% in those with PCa (figure 2).

Our cohort represents the largest known cohort with heart failure treated by LVAD/HT and PCa. Our median age of 59 at PCa diagnosis is considerably younger than the national median of 66.1 Of the 4 individuals diagnosed with PCa, 3 had high grade disease. Given the favorable long-term survival of these patients post-LVAD/HT, age-appropriate treatment for PCa should be continued post-implantation.

Urology. 2019 Nov 28 [Epub ahead of print]

Harry H Lee, Nathan Shaw, Selma Mohammed, Keith Kowalczyk, Lambros Stamatakis, Ross E Krasnow

Georgetown University School of Medicine. 3800 Reservoir Rd Washington DC., MedStar Georgetown Department of Urology. 3800 Reservoir Rd Pasquerilla Health Center 1 Washington, DC. Electronic address: ., Medstar Washington Heart and Vascular Institute: Advanced Heart Failure. 110 Irving Street Northwest Suite 4B-1 Washington, DC 20010., MedStar Georgetown Department of Urology. 3800 Reservoir Rd Pasquerilla Health Center 1 Washington, DC., MedStar Georgetown Department of Urology, 110 Irving Street POB South 3rd floor.