Screening recommendations for prostate cancer remain controversial, and no specific guidelines exist for screening in renal transplant candidates. To examine whether the use of prostate-specific antigen (PSA)-based screening in patients with ESRD affects time to transplantation and transplant outcomes, we retrospectively analyzed 3782 male patients ≥18 years of age undergoing primary renal transplant evaluation during a 10-year period.
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Patients were grouped by age per American Urological Association screening guidelines: group 1, patients <55 years; group 2, patients 55-69 years; and group 3, patients >69 years. A positive screening test result was defined as a PSA level >4 ng/ml. We used univariate analysis and Cox proportional hazards models to identify the independent effect of screening on transplant waiting times, patient survival, and graft survival. Screening was performed in 63. 6% of candidates, and 1198 candidates (31. 7%) received kidney transplants. PSA screening was not associated with improved patient survival after transplantation (P=0. 24). However, it did increase the time to listing and transplantation for candidates in groups 1 and 2 who had a positive screening result (P<0. 05). Furthermore, compared with candidates who were not screened, PSA-screened candidates had a reduced likelihood of receiving a transplant regardless of the screening outcome (P<0. 001). These data strongly suggest that PSA screening for prostate cancer may be more harmful than protective in renal transplant candidates because it does not appear to confer a survival benefit to these candidates and may delay listing and decrease transplantation rates.
Journal of the American Society of Nephrology : JASN. 2015 Dec 23 [Epub ahead of print]
Gerardo A Vitiello, Blayne A Sayed, Marla Wardenburg, Sebastian D Perez, Christopher G Keith, Daniel J Canter, Kenneth Ogan, Thomas C Pearson, Nicole Turgeon
Department of Transplant Surgery and Department of Surgery, NYU Langone Medical Center, New York, New York;, Department of Transplant Surgery and. , Department of Transplant Surgery and Department of Urology, University of Florida, Gainesville, Florida; and. , Department of Transplant Surgery and. , Department of Transplant Surgery and. , Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania. , Department of Urology, Emory University, Atlanta, Georgia;, Department of Transplant Surgery and. , Department of Transplant Surgery