The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression.
We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting.
We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60-73) and 45.9 mL/min (IQR 31.5-63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48-191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02-10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31-106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16-0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS.
PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
Cancers. 2022 Dec 28*** epublish ***
Giancarlo Marra, Francesco Soria, Federica Peretti, Marco Oderda, Charles Dariane, Marc-Olivier Timsit, Julien Branchereau, Oussama Hedli, Benoit Mesnard, Derya Tilki, Jonathon Olsburgh, Meghana Kulkarni, Veeru Kasivisvanathan, Cedric Lebacle, Oscar Rodriguez-Faba, Alberto Breda, Timo Soeterik, Giorgio Gandaglia, Paola Todeschini, Luigi Biancone, Paolo Gontero
Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy., Department of Urology, Hôpital Européen Georges Pompidou, 75015 Paris, France., Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany., Department of Urology, Guy's Hospital, London SE1 9RT, UK., University College London, London WC1E 6BT, UK., Department of Urology, Kremlin-Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France., Department of Urology, Fundacio Puigvert, 08025 Barcelona, Spain., Department of Urology, Saint Antonius Hospital, 3543 AZ Utrecht, The Netherlands., Department of Urology, San Raffaele Hospital, 20132 Milan, Italy., Department of Nephrology, Sant'Orsola Malpighi Hospital, 40138 Bologna, Italy.