The role of immunosuppression in prostate cancer (PCa) mortality is a debated topic, with a low level of evidence. This review aims to evaluate the cancer-specific mortality (CSM) and overall mortality (OM) of PCa in immunocompromised patients compared with immunocompetent individuals.
A literature search was conducted in the PubMed/Medline, Embase, and Web of Science databases (up to the March 31, 2024). The analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42022361504). Data were pooled using a fixed-effect model and adjusted hazard ratios (HRs).
A total of 13 studies (n ≈ 3.4 million PCa patients) were included in the qualitative analysis; 11 studies were included in the quantitative analysis. The forest plot for CSM in immunocompromised patients failed to reach statistical significance (HR 1.04 [95% confidence interval {CI}, 0.91-1.18], p = 0.57). OM was higher in the immunocompromised cohort (HR 2.04 [95% CI, 1.94-2.15], p < 0.001). CSM for transplanted patients was comparable with that for the controls (HR 1.01 [95% CI, 0.86-1.18], p = 0.94). Patients with human immunodeficiency virus (HIV) had higher CSM rates (HR 1.83 [95% CI, 1.21-2.75], p = 0.004). Limitations included retrospective cohort studies and heterogeneity in reporting PCa stages.
Transplanted patients present a CSM rate comparable with the controls, despite a higher OM rate. Other immunocompromised patients present an overall worse prognosis. The treatment algorithm should be applied by international guidelines for transplanted patients, delivering more aggressive treatments and screening strategies.
European urology oncology. 2025 Jun 17 [Epub ahead of print]
Francesco Sanguedolce, Alessandro Tedde, Giuseppe Basile, Francesco Di Bello, Michael Baboudjian, Alessandro Uleri, Stefano Mancon, Daria Chernysheva, Marta Roqué Figuls, Andrea Gallioli, Angelo Territo, Morgan Rouprêt, Joan Palou, Alberto Breda
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Medicine, Surgery and Pharmacy, Università degli Studi di Sassari, Sassari, Italy., Department of Medicine, Surgery and Pharmacy, Università degli Studi di Sassari, Sassari, Italy., Department of Urology, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Department of Urology, APHM, North Academic Hospital, Marseille, France., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain., Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain., Urology Department, GRC n°5, Predictive Onco-Uro, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40533295