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Okumi M, Inoue Y, Miyashita M, Ueda T, Fujihara A, Hongo F, Ukimua O. Genitourinary malignancies in kidney transplant recipients. Int J Urol 2024. [PMID: 39316503 DOI: 10.1111/iju.15588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/09/2024] [Indexed: 09/26/2024]
Abstract
Advances in immunosuppressive therapy and postoperative management have greatly improved the graft and patient survival rates after kidney transplantation; however, the incidence of post-transplant malignant tumors is increasing. Post-renal transplantation malignant tumors are associated with renal failure, immunosuppression, and viral infections. Moreover, the risk of developing cancer is higher in kidney transplant recipients than in the general population, and the tendency to develop cancer is affected by the background and environment of each patient. Recently, cancer after kidney transplantation has become the leading cause of death in Japan. Owing to the aggressive nature and poor prognosis of genitourinary malignancies, it is crucial to understand their epidemiology, risk factors, and best practices in kidney transplant recipients. This review has a special emphasis on the epidemiology, risk factors, and treatment protocols of genitourinary malignancies in kidney transplant recipients to enhance our understanding of the appropriate management strategies. Optimal immunosuppressive therapy and cancer management for these patients remain controversial, but adherence to the general guidelines is recommended.
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Affiliation(s)
- Masayoshi Okumi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Inoue
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatsugu Miyashita
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Ueda
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimua
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Dat A, Wei G, Knight S, Ranasinghe W. The role of localised prostate cancer treatment in renal transplant patients: A systematic review. BJUI COMPASS 2023; 4:622-658. [PMID: 37818029 PMCID: PMC10560625 DOI: 10.1002/bco2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 10/12/2023] Open
Abstract
Objective To systematically review and critically appraise all treatment options for localised prostate cancer in renal transplant candidates and recipients. Method A systematic review was conducted adhering to PRISMA guidelines. Searches were performed in the Cochrane Library, Embase, Medline, the Transplant Library and Trip database for studies published up to September 2022. Risk of bias was assessed with the Cochrane Risk of Bias in Non-Randomised Studies of Interventions for non-randomised studies tool. Results A total of 60 studies were identified describing 525 patients. The majority of studies were either retrospective non-randomised comparative or case series/reports of poor quality. The vast majority of studies were focussed on prostate cancer after renal transplantation. Overall, 410 (78%) patients underwent surgery, 93 (18%) patients underwent radiation therapy or brachytherapy, one patient underwent focal therapy (high-intensity frequency ultrasound) and 21 patients were placed on active surveillance. The mean age was 61 years old, the mean PSA level at diagnosis was 9.6 ng/mL and the mean follow-up time was 31 months. The majority of patients had low-risk disease with 261 patients having Gleason 6 prostate cancer (50%), followed by 220 Gleason 7 patients (42%). All prostate cancer mortality cases were in high-risk prostate cancer (≥Gleason 8). The cancer-specific survival results were similar between surgery and radiotherapy at 1 and 3 years. Conclusion Localised prostate cancer treatment in renal transplant patients should be risk stratified. Surgery and radiation treatment for localised prostate cancer in renal transplant patients appear equally efficacious. Given the limitations of this study, future research should concentrate on developing a multicentre RCT with long-term registry follow-up.
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Affiliation(s)
- Anthony Dat
- Department of UrologyMonash HealthMelbourneAustralia
| | - Gavin Wei
- Department of UrologyMonash HealthMelbourneAustralia
| | - Simon Knight
- Department of Transplantation, Centre for Evidence in TransplantationJohn Radcliffe HospitalOxfordUK
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Hanusz K, Domański P, Strojec K, Zapała P, Zapała Ł, Radziszewski P. Prostate Cancer in Transplant Receivers-A Narrative Review on Oncological Outcomes. Biomedicines 2023; 11:2941. [PMID: 38001942 PMCID: PMC10669184 DOI: 10.3390/biomedicines11112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Prostate cancer (PCa) is a low tumor mutational burden (TMB) cancer with a poor response to immunotherapy. Nonetheless, immunotherapy can be useful, especially in metastatic castration-resistant PCa (mCRPC). Increased cytotoxic T lymphocytes (CTLs) density is correlated with a shorter overall survival (OS), an early biochemical relapse, and a generally poor PCa prognosis. An increased number of CCR4+ regulatory T cells (CCR4 + Tregs) relates to a higher Gleason score or earlier progression. The same therapeutic options are available for renal transplant recipients (RTRs) as for the population, with a comparable functional and oncological outcome. Radical retropubic prostatectomy (RRP) is the most common method of radical treatment in RTRs. Brachytherapy and robot-assisted radical prostatectomy (RARP) seem to be promising therapies. Further studies are needed to assess the need for prostatectomy in low-risk patients before transplantation. The rate of adverse pathological features in RTRs does not seem to differ from those observed in the non-transplant population and the achieved cancer control seems comparable. The association between PCa and transplantation is not entirely clear. Some researchers indicate a possible association between a more frequent occurrence of PCa and a worse prognosis in advanced or metastatic PCa. However, others claim that the risk and survival prognosis is comparable to the non-transplant population.
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Affiliation(s)
- Karolina Hanusz
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Domański
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Kacper Strojec
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
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Urological Cancers and Kidney Transplantation: a Literature Review. Curr Urol Rep 2021; 22:62. [PMID: 34913107 DOI: 10.1007/s11934-021-01078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). RECENT FINDINGS Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.
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Sirisopana K, Jenjitranant P, Sangkum P, Kijvikai K, Pacharatakul S, Leenanupunth C, Kochakarn W, Kongchareonsombat W. Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients. BMC Urol 2021; 21:97. [PMID: 34229680 PMCID: PMC8259354 DOI: 10.1186/s12894-021-00862-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. Methods We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. Results Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. Conclusions Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.
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Affiliation(s)
- Kun Sirisopana
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Pocharapong Jenjitranant
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Suthep Pacharatakul
- Division of Urology, Department of Surgery, Police Hospital, Bangkok, Thailand
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Wachira Kochakarn
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
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Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients. Brachytherapy 2018; 17:808-815. [DOI: 10.1016/j.brachy.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
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Zeng J, Christiansen A, Pooli A, Qiu F, LaGrange CA. Safety and Clinical Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A Systematic Review. J Endourol 2018; 32:935-943. [PMID: 30039723 DOI: 10.1089/end.2018.0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature. MATERIALS AND METHODS A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review. RESULTS We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%. CONCLUSIONS RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.
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Affiliation(s)
- Jiping Zeng
- 1 College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska
| | - Andrew Christiansen
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
| | - Aydin Pooli
- 3 Department of Urology, David Geffen School of Medicine at University of California , Los Angeles, California
| | - Fang Qiu
- 4 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - Chad A LaGrange
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
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Narváez A, Suarez J, Riera L, Castells-Esteve M, Cocera R, Vigués F. Our experience in the management of prostate cancer in renal transplant recipients. Actas Urol Esp 2018; 42:249-255. [PMID: 29395386 DOI: 10.1016/j.acuro.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of Prostate cancer (PCa) in renal transplant recipients (RTR) is challenging and remain controversial. Currently there is no consensus about this condition. The aim of the study was to analyse our experience in the diagnosis and management of PCa in RTR. METHOD Retrospective monocentric study of a prospective and consecutive database from 2003-2017. Inclusion of RTR diagnosed of PCa. Staging and treatment in agreement with the contemporary guidelines. The main outcome measures included clinical staging, type of treatment, oncological outcomes and follow-up. RESULTS 1,330 renal transplants were performed (787 males), diagnosed of PCa in 33 RTR (4.2%), mean age 66years±6.3 (51-78). Median PSA was 8.8ng/ml and PSA ratio 0.19. Mean time between renal transplantation and PCa diagnosis 130months±90 (2-236). TREATMENTS Radical prostatectomy (RP) (n=22; 66.7%), Radiation therapy (RT) with Androgen deprivation therapy (ADT) (n=7; 21.2%), Active surveillance (n=3; 9.1%), ADT (n=1; 3%). No graft loss neither impaired renal function due to PCa treatment was reported. After RP two patients (9.1%) presented biochemical recurrence treated with RT. Remission of the 100%. Mean follow-up was 61months±37 (6-132). CONCLUSIONS PCa in renal transplant patients can be managed with the same therapeutic options as in the general population. Active surveillance should also be provided in RTR despite being under immunosuppressive therapy.
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Sherer BA, Warrior K, Godlewski K, Hertl M, Olaitan O, Nehra A, Deane LA. Prostate cancer in renal transplant recipients. Int Braz J Urol 2018; 43:1021-1032. [PMID: 28338305 PMCID: PMC5734064 DOI: 10.1590/s1677-5538.ibju.2016.0510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/03/2016] [Indexed: 12/25/2022] Open
Abstract
As patients with end-stage renal disease are receiving renal allografts at older ages, the number of male renal transplant recipients (RTRs) being diagnosed with prostate cancer (CaP) is increasing. Historically, the literature regarding the management of CaP in RTR's is limited to case reports and small case series. To date, there are no standardized guidelines for screening or management of CaP in these complex patients. To better understand the unique characteristics of CaP in the renal transplant population, we performed a literature review of PubMed, without date limitations, using a combination of search terms including prostate cancer, end stage renal disease, renal transplantation, prostate cancer screening, prostate specific antigen kinetics, immuno-suppression, prostatectomy, and radiation therapy. Of special note, teams facilitating the care of these complex patients must carefully and meticulously consider the altered anatomy for surgical and radiotherapeutic planning. Active surveillance, though gaining popularity in the general low risk prostate cancer population, needs further study in this group, as does the management of advance disease. This review provides a comprehensive and contemporary understanding of the incidence, screening measures, risk stratification, and treatment options for CaP in RTRs.
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Affiliation(s)
- Benjamin A Sherer
- Department of Urology, Rush University Medical Center, Chicago, Illinois, United States
| | - Krishnan Warrior
- Department of Urology, Rush University Medical Center, Chicago, Illinois, United States
| | - Karl Godlewski
- Department of Urology, Rush University Medical Center, Chicago, Illinois, United States
| | - Martin Hertl
- Department of Surgery, Abdominal Transplant, Rush University Medical Center, Chicago, Illinois, United States
| | - Oyedolamu Olaitan
- Department of Surgery, Abdominal Transplant, Rush University Medical Center, Chicago, Illinois, United States
| | - Ajay Nehra
- Department of Urology, Rush University Medical Center, Chicago, Illinois, United States
| | - Leslie Allan Deane
- Department of Urology, Rush University Medical Center, Chicago, Illinois, United States
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Kleinclauss F, Thuret R, Murez T, Timsit M. Transplantation rénale et cancers urologiques. Prog Urol 2016; 26:1094-1113. [DOI: 10.1016/j.purol.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
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Le Clerc QC, Lecornet E, Leon G, Rigaud J, Glemain P, Branchereau J, Karam G. Technical feasibility of robot-assisted laparoscopic radical prostatectomy in renal transplant recipients: Results of a series of 12 consecutive cases. Can Urol Assoc J 2015; 9:E490-3. [PMID: 26279722 PMCID: PMC4514498 DOI: 10.5489/cuaj.2319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluate the technical feasibility of robotic prostatectomy in renal transplant recipients. METHODS We retrospectively analyzed preoperative and perioperative settings, as well as functional and oncologic results of 12 patients operated on between 2009 and 2013. Prostatectomy was performed via a transperitoneal approach without any changing in the ports position. The average age was 61.92 ± 2.98 years. The period between transplant and the diagnosis of adenocarcinoma was 79.7 months. The mean PSA was 7.34 ng/mL (range: 4.9-11). RESULTS The operative time was 241.3 ± 35.6 minutes with only one conversion and one transfusion. The intervention was difficult due to adhesions on the side of the graft in 50% of cases. There was a case of obstructive acute renal failure resulting from a hematoma of the Retzius treated by percutaneous nephrostomy at D20. There was a majority of pT2c (72.7%), including 3 positive margins (27.3%) and 2 biochemical relapses treated with radiotherapy and hormonotherapy, respectively. The end point prostate-specific antigen was undetectable. There was no significant difference between preoperative and J7 creatinine (p = 0. 22). CONCLUSIONS Robotic prostatectomy in renal transplant recipients is a safe technique with no serious effects on the allograft.
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Affiliation(s)
| | - Emilie Lecornet
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
| | - Gregoire Leon
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
| | - Jerome Rigaud
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
| | - Pascal Glemain
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
| | - Julien Branchereau
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
| | - Georgess Karam
- Clinique Urologique, CHU Nantes Hôtel-Dieu 1 Place Alexis Ricordeau, Nantes Cedex
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Heidenreich A, Pfister D, Thissen A, Piper C, Porres D. Radical retropubic and perineal prostatectomy for clinically localised prostate cancer in renal transplant recipients. Arab J Urol 2014; 12:142-8. [PMID: 26019939 PMCID: PMC4434433 DOI: 10.1016/j.aju.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 01/05/2014] [Accepted: 01/12/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To analyse the functional and oncological outcome of consecutive renal-transplant recipients (RTRs) with clinically localised prostate cancer who underwent radical retropubic (RRP) or perineal (RPP) prostatectomy. Patients and methods Between January 2000 and July 2011 16 patients underwent RRP (group 1) and seven RPP (group 2). In all, 200 consecutive non-RTRs served as the control group, of whom 100 each underwent RRP and RPP, respectively. The mean (range) interval between renal transplantation and RP was 95 (24–206) months, the PSA at the time of diagnosis was 4.5 (3.0–17.5) ng/mL, and the mean patient age was 64 (59–67) years. Results The mean follow-up was 39 (RRP) and 48 months (RPP). There was no deterioration in graft function. In group 1, 13 and three patients had pT2a-cpN0 and pT3a-bpN0 prostate cancer, respectively, with a Gleason score of 6, 7 and 8 in 11, three and one patients, respectively. In group 2, three and four patients had pT2a-c and pT3a-b disease, respectively, with a Gleason score of 6 and 7 in two and five, respectively. In both groups one patient had a positive surgical margin and was followed expectantly, and all patients have no evidence of disease. Wound infections developed more often in the RPP group (29% vs. 7%), but there were no Clavien grade III–V complications. All patients achieved good continence, and two need one pad/day. Conclusions RRP and RPP are suitable surgical treatments for prostate cancer in RTRs. RRP might be preferable, as it has the advantage of simultaneous pelvic lymphadenectomy and a lower risk of infectious complications.
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Affiliation(s)
| | - David Pfister
- Department of Urology, RWTH University Aachen, Germany
| | | | | | - Daniel Porres
- Department of Urology, RWTH University Aachen, Germany
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Ghazi A, Erturk E, Joseph JV. Modifications to facilitate extraperitoneal robot-assisted radical prostatectomy post kidney transplant. JSLS 2013; 16:314-9. [PMID: 23477187 PMCID: PMC3481245 DOI: 10.4293/108680812x13427982376626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Extraperitoneal robotic-assisted radical prostatectomy in carefully selected renal allograft recipients may be feasible in avoiding injury to the renal allograft, transplanted ureter, and ureteroneocystostomy. Introduction: Renal transplantation is the treatment of choice for patients with end-stage renal failure. With advances in immunosuppression, the short-term and long-term outcome has improved significantly. Subsequently, urologists are encountering more transplant recipients with genitourinary malignancies, and therefore urologists are becoming increasingly compelled to offer curative treatment options. Materials and Methods: We present modifications to facilitate E-RARP in these patients that include modified trocar arrangement, delayed bladder neck transection, utilizing the robotic Hem-o-lok applier, and posterior reconstruction of the anastomosis using a barbed V-loc suture. A 68-year-old male with a history of polycystic kidney disease, end-stage renal failure, and an allograft renal transplantation in the right iliac fossa, presented with T1c, Gleason 3+4 prostate cancer. He had a preoperative PSA of 6.93ng/mL, ASA score of 3, and a BMI of 26kg/m2. Follow-up for metastasis (MRI and bone scan) was negative. E-RARP was performed via the extraperitoneal approach using a 5-port 2-arm approach at an insufflation pressure of 10mm Hg. Results: The radical prostatectomy was successfully performed. Ureterovesical anastomosis was completed, and total console time was 130 minutes, with an estimated blood loss of 125mL. Final pathology was T2bNx, Gleason 3+4 with negative surgical margins. The patient was discharged with no change in serum creatinine or GFR. The catheter was removed on POD 10 with no intraoperative or immediate postoperative complications. Conclusion: E-RARP in the carefully selected renal allograft recipient is feasible and accomplished safely with technical modifications to avoid injuring the renal allograft, transplanted ureter, and ureteroneocystostomy.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Polcari AJ, Allen JC, Nunez-Nateras R, Mmeje CO, Andrews PE, Milner JE, Castle EP, Woods ME. Multicenter experience with robot-assisted radical prostatectomy in renal transplant recipients. Urology 2013. [PMID: 23206772 DOI: 10.1016/j.urology.2012.08.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate our multi-institutional outcome with robot-assisted radical prostatectomy (RARP) in renal transplant recipients and describe technical modifications of the procedure. MATERIALS AND METHODS We retrospectively reviewed 1677 patients, 1422 from Mayo Clinic Arizona and 255 from Loyola University Medical Center, undergoing RARP from March 2004 to October 2010, of which 7 were renal transplant recipients. Baseline demographic features, perioperative data, and oncologic outcomes were reviewed. RESULTS At diagnosis, mean patient age was 63.3 years and serum prostate specific antigen was 6.17 ng/mL. The mean total operative time was 186 minutes (range, 80-210 minutes). No intraoperative complications were noted. The mean hospital length of stay was 1.8 days (range, 1-3 days). Clavien grade II postoperative complications occurred in 3 of the 7 patients (42.9%), consisting of urosepsis, atrial fibrillation, and gross hematuria, all resolving with appropriate medical management. No significant changes were observed in graft function. Two patients (28.6%) had positive surgical margins. During a mean follow-up of 16 months, 1 patient with pathologic T3a, Gleason 9 cancer experienced a biochemical recurrence, which was treated with salvage external-beam radiation and androgen-deprivation therapy. CONCLUSION Our series suggests that RARP is a safe and feasible form of therapy for localized prostate cancer in a select group of renal transplant recipients.
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Affiliation(s)
- Anthony J Polcari
- Department of Urology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Wagener N, Nyarangi-Dix J, Teber D, Zeier M, Hohenfellner M. Applicability of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Allograft Recipients. Transplant Proc 2012; 44:1287-92. [DOI: 10.1016/j.transproceed.2012.01.120] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
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17
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Smith DL, Jellison FC, Heldt JP, Tenggardjaja C, Bowman RJ, Jin DH, Chamberlin J, Lui PD, Baldwin DD. Robot-Assisted Radical Prostatectomy in Patients with Previous Renal Transplantation. J Endourol 2011; 25:1643-7. [DOI: 10.1089/end.2011.0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Damien L. Smith
- Department of Urology, Loma Linda University, Loma Linda, California
| | | | - Jonathan P. Heldt
- Department of Urology, Loma Linda University, Loma Linda, California
| | | | - Ryan J. Bowman
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Daniel H. Jin
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Joshua Chamberlin
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Paul D. Lui
- Department of Urology, Loma Linda University, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University, Loma Linda, California
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Binsaleh S. Diagnosis and treatment of prostate cancer in renal-transplant recipients. Int Urol Nephrol 2011; 44:149-55. [DOI: 10.1007/s11255-011-9988-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 04/30/2011] [Indexed: 12/18/2022]
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Hoda MR, Hamza A, Greco F, Wagner S, Reichelt O, Heynemann H, Fischer K, Fornara P. Management of localized prostate cancer by retropubic radical prostatectomy in patients after renal transplantation. Nephrol Dial Transplant 2010; 25:3416-20. [DOI: 10.1093/ndt/gfq193] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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20
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Maestro MÁ, Gómez AT, Alonso y Gregorio S, Ledo JC, de la Peña Barthel J, Martínez-Piñeiro L. Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: a review of the literature. BJU Int 2010; 105:844-8. [DOI: 10.1111/j.1464-410x.2009.08911.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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di Capua Sacoto C, Luján Marco S, Bahilo Mateu P, Budía Alba A, Pontones Moreno J, Jiménez Cruz J. Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70015-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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22
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[Current value of laparoscopy for renal transplantation]. Urologe A 2009; 48:1478-82. [PMID: 19936697 DOI: 10.1007/s00120-009-2187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.
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Robert G, Elkentaoui H, Pasticier G, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H. Laparoscopic Radical Prostatectomy in Renal Transplant Recipients. Urology 2009; 74:683-7. [DOI: 10.1016/j.urology.2009.04.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/09/2009] [Accepted: 04/05/2009] [Indexed: 11/28/2022]
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Breyer BN, Whitson JM, Freise CE, Meng MV. Prostate cancer screening and treatment in the transplant population: current status and recommendations. J Urol 2009; 181:2018-25; discussion 2025-6. [PMID: 19286214 DOI: 10.1016/j.juro.2009.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Indexed: 01/20/2023]
Abstract
PURPOSE We reviewed the current status of and recommendations for prostate cancer screening and treatment in the solid organ transplant population. MATERIALS AND METHODS We performed a MEDLINE search to identify published data regarding prostate cancer screening, risk, treatment and outcomes in the solid organ transplant population. The literature was reviewed and summarized. RESULTS Most data regarding outcomes of prostate cancer treatment in the transplant population are limited to case reports and small series, and primarily involve renal insufficiency. It does not appear that the development or natural history of prostate cancer is significantly affected by organ failure or subsequent transplantation. Thus, prostate specific antigen testing and screening protocols can be extrapolated from the general population. However, the balance of comorbid diseases and estimated limitations in life expectancy must be carefully considered, and emphasis should be placed on risk assessment. Prostatectomy appears to be feasible with outcomes comparable to those in the non-transplant population, while data regarding the use of radiation therapy are limited. CONCLUSIONS The expansion of organ transplant criteria, including older donors and recipients, combined with improved allograft survival has enhanced the relevance of prostate cancer screening and treatment in this group. Greater awareness of the issues surrounding prostate cancer incidence, detection and natural history should promote improved data collection, screening and treatment of prostate cancer in the transplant population.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology and Surgery, Division of Transplant Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
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Antonopoulos IM, Nahas WC, Piovesan AC, Falci R, Kanashiro H, Alvarez GA, Srougi M. Radical Retropubic Prostatectomy for Localized Prostate Cancer in Renal Transplant Patients. Urology 2008; 72:1362-5. [DOI: 10.1016/j.urology.2008.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/20/2008] [Accepted: 03/26/2008] [Indexed: 11/26/2022]
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Jhaveri JK, Tan GY, Scherr DS, Tewari AK. Robot-Assisted Laparoscopic Radical Prostatectomy in the Renal Allograft Transplant Recipient. J Endourol 2008; 22:2475-9. [DOI: 10.1089/end.2008.0280] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jay K. Jhaveri
- James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York, New York
| | - Gerald Y.M. Tan
- James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York, New York
| | - Douglas S. Scherr
- James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York, New York
| | - Ashutosh K. Tewari
- James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York, New York
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