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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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Liauw SL, Ham SA, Das LC, Rudra S, Packiam VT, Koshy M, Weichselbaum RR, Becker YT, Bodzin AS, Eggener SE. Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis. J Natl Cancer Inst 2021; 112:847-854. [PMID: 31728517 DOI: 10.1093/jnci/djz221] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/01/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunosuppressive regimens associated with organ transplantation increase the risk of developing cancer. Transplant candidates and recipients with prostate cancer are often treated, even if low-risk features would ordinarily justify active surveillance. METHODS Using SEER-Medicare, we identified 163 676 men aged 66 years and older diagnosed with nonmetastatic prostate cancer. History of solid organ transplant was identified using diagnosis or procedure codes. A propensity score-matched cohort was identified by matching transplanted men to nontransplanted controls by age, race, region, year, T-stage, grade, comorbidity, and cancer therapy. Fine-Gray competing risk models assessed associations between transplant status and prostate cancer-specific mortality (PCSM) and overall mortality (OM). RESULTS We identified 620 men (0.4%) with transplant up to 10 years before (n = 320) or 5 years after (n = 300) prostate cancer diagnosis and matched them to 3100 men. At 10 years, OM was 55.7% and PCSM was 6.0% in the transplant cohort compared with 42.4% (P < .001) and 7.6% (P = .70) in the nontransplant cohort, respectively. Adjusted models showed no difference in PCSM for transplanted men (hazard ratio = 0.88, 95% confidence interval = 0.61 to 1.27, P = .70) or differences by prostate cancer therapy. Among 334 transplanted men with T1-2N0, well or moderately differentiated "low-risk" prostate cancer, PCSM was similar for treated and untreated men (hazard ratio = 0.92, 95% confidence interval = 0.47 to 1.81). CONCLUSIONS Among men aged 66 years and older with prostate cancer, an organ transplant is associated with higher OM but no observable difference in PCSM. These findings suggest men with prostate cancer and previous or future organ transplantation should be managed per usual standards of care, including consideration of active surveillance for low-risk cancer characteristics.
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Affiliation(s)
| | | | - Lauren C Das
- Department of Radiation and Cellular Oncology, Beacon Health System, Elkhart, IN
| | - Sonali Rudra
- University of Chicago, Chicago, IL.,Department of Radiation Oncology, Georgetown University, Washington, DC
| | | | | | | | - Yolanda T Becker
- Department of Transplant Surgery, University of Chicago, Chicago, IL
| | - Adam S Bodzin
- Department of Transplant Surgery, Jefferson University Hospitals, Philadelphia, PA
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The role of radiotherapy in patients with solid tumours after solid organ transplantation: a systematic review. Lancet Oncol 2021; 22:e93-e104. [PMID: 33662300 DOI: 10.1016/s1470-2045(20)30590-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
For patients diagnosed with cancer who have previously received an organ transplant, radiotherapy represents a challenging clinical scenario without well established care algorithms. Immunosuppressive therapy can be a cause for concern among clinicians treating this category of patients. Potential immune modulation following irradiation could affect recipient organ tolerance and the outcomes of the transplantation itself. The main aim of this systematic review was to define the safety and effectiveness of radiotherapy in patients diagnosed with cancer who have previously received an organ transplant. We searched PubMed and Embase for articles published between Jan 1, 1995, and April 30, 2020 for studies in patients who had undergone radiotherapy for post-transplantation malignancies. The Review is framed by the PICO (population, intervention, control, and outcomes) criteria, and primarily focuses on modern treatment techniques.
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Ileana PÁS, Rubi RP, Javier LRF, Sagrario MGMD, Haydeé FBC. Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases. Rep Pract Oncol Radiother 2020; 25:548-555. [PMID: 32494227 DOI: 10.1016/j.rpor.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/23/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
Aim Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. Background The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. Materials and methods We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. Cases description We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). Conclusion When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient's specific setting. Recent publications recommend KT mean dose <4 Gy, but graft proximity to CTV makes this unfeasible. We present 2 cases where dose constraint was not achieved, and to a short follow-up of 20 months renal toxicity has not been documented. We recommend the lowest possible mean dose to the KT, but never compromising the CTV coverage, since morbimortality from recurrent or progressive cancer disease outweighs the risk of graft injury.
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Key Words
- BF, Biochemical failure
- BT, Brachytherapy
- C3D-RT, Conformal three-dimensional radiation therapy
- CBCT, Cone-beam computed tomography
- CCa, Cervix cancer
- Dmax, Maximum dose
- Dmean, Mean dose
- Dmin, Minimum dose
- Dx, Dose (in Gy) receiving x% of a volume or more
- EBRT, External beam radiation therapy
- EQD2, Equivalent dose in 2-Gy fractions
- ESKD, End-stage kidney disease
- FU, Follow-up
- HPV, Human papillomavirus
- IBT, Intracavitary brachytherapy
- IMRT, Intensity-modulated radiation therapy
- KT, Kidney transplant
- Kidney allograft
- LRDRT, Living related donor renal transplantation
- MMF, Mycophenolate mofetil
- NED, No evidence of disease
- OAR, Organs at risk
- OS, Overall survival
- PCa, Prostate cancer
- PDN, Prednisone
- PP, Post-prostatectomy
- PSA, Prostate-specific antigen
- PTV, Planning target volume
- Pelvic radiotherapy
- Prostate cancer
- RR, Risk ratio
- RT, Radiation therapy
- Renal transplant
- SCCVa, Squamous cell carcinoma of the vagina
- SIR, Standardized Incidence Ratio
- TBI, Total body irradiation
- VCa, Vaginal cancer
- VMAT, Volumetric Modulated Arc Therapy
- Vaginal cancer
- Vx, Volume (in percentage) receiving x dose or more (in Gy)
- fr, Fractions
- mo, Months
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Affiliation(s)
- Pérez Álvarez Sandra Ileana
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Ramos Prudencio Rubi
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Lozano Ruiz Francisco Javier
- Department of Radiation Oncology, Médica Sur Hospital. 150 Puente de Piedra, Toriello Guerra, Tlalpan, Mexico City, 14050, Mexico
| | | | - Flores Balcazar Christian Haydeé
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
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Morbidity, perioperative outcomes and complications of robot-assisted radical prostatectomy in kidney transplant patients: A French multicentre study. Urol Oncol 2020; 38:599.e15-599.e21. [PMID: 31948931 DOI: 10.1016/j.urolonc.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/25/2019] [Accepted: 12/19/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Evaluate the safety, feasibility and efficiency of robot-assisted radical prostatectomy (RARP) in kidney transplant recipients, performed in high-volume French referral centres, and describe intra- and postoperative, oncological and functional outcomes. MATERIALS AND METHODS A multicentre study was conducted on prospective RARP databases from 5 centres between 2008 and 2017. We retrospectively identified a first group (G1) of transplant patients. The following data were collected: age, body mass index, prostate-specific antigen, ISUP score, TNM stage, stratification according to d'Amico, renal function, renal disease, time between renal transplant and prostate cancer (PCa), operating time, bleeding, pre- and postoperative complications (according to Clavien). Group 1 data were matched with a second group (G2) of nontransplanted PTRA patients. RESULTS A total of 321 patients were included (G1 N = 39 and G2 N = 282). The median operating time was 180 minutes (interquartile range 125-227) for G1 and 150 minutes (120-180) in G2 (P = 0.0623) and the median bleeding volume was 150 mL (150-400) and 250 mL (175-400), respectively (P = 0.1826). No grafts were damaged by RARP. Postoperative complication rate was significantly higher in G1: 51.2% vs. G2: 8.2% with a majority of minor complications (41%) according to Clavien Dindo (P < 0.001). Pathological assessment was as follows in G1: T2 = 28 (71.8%), T3 = 11 (28.2%), and G2: T2 = 206 (73.3%), T3 = 75 (26.7%) (P = 0.77). Postoperative ISUP scores were mainly grade 1: G1 = 14 (35.9%) vs. 99 (35.2%) in G2 and grade 2: respectively 18 (46.1%) 94 (33.5%). The rate of positive surgical margins was comparable in both groups: 13.2% for transplant patients vs. 18.1% (P = 0.65). Renal function was not significantly different at one year (P = 0.07). The median follow-up was 47.9 months (42.3; 52.5). CONCLUSION RARP is conceivable to treat localized prostate cancer in kidney transplant recipients. This procedure does not appear to have any negative impact on graft renal function and cancer prognosis.
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Bosacki C, Vallard A, Jmour O, Ben Mrad M, Lahmamssi C, Bousarsar A, Vial N, Guillaume E, Daguenet E, Magné N. [Radiotherapy and immune suppression: A short review]. Bull Cancer 2019; 107:84-101. [PMID: 31866074 DOI: 10.1016/j.bulcan.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023]
Abstract
The management of patients undergoing immunosuppressive agents is really challenging. Based on precaution principle, it seems mandatory to stop immunosuppressive (or immunomodulating) agents during radiation. Yet, it is impossible in grafted patients. It is possible in patients with autoimmune disease, but in this case, the autoimmune disease might modify patient's radio-sensitivity. We provide a short review about the safety of radiotherapy in grafted/auto-immune patients. The literature is limited with data coming from outdated case-report or case-control studies. It seems that radiotherapy is feasible in grafted patients, but special dose-constraints limitations must probably be considered for the transplant and the other organs at risk. There is very little data about the safety of radiotherapy, when associated with immunomodulating agents. The most studied drug is the methotrexate but only its prescription as a chemotherapy (high doses for a short period of time) was reported. When used as an immunomodulator, it should probably be stopped 4 months before and after radiation. Apart from rheumatoid arthritis, it seems that collagen vascular diseases and especially systemic scleroderma and systemic lupus erythematous feature increased radio-sensitivity with increased severe late toxicities. Transplanted patients and collagen vascular disease patients should be informed that there is very little data about safety of radiation in their case.
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Affiliation(s)
- Claire Bosacki
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Omar Jmour
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Majed Ben Mrad
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Chaimaa Lahmamssi
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Amal Bousarsar
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Nicolas Vial
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Elodie Guillaume
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Elisabeth Daguenet
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut de cancérologie Lucien-Neuwirth, département universitaire de recherche et éducation, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut de cancérologie Lucien-Neuwirth, département universitaire de recherche et éducation, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
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Tasaki M, Kasahara T, Kaidu M, Kawaguchi G, Hara N, Yamana K, Maruyama R, Takizawa I, Ishizaki F, Saito K, Nakagawa Y, Ikeda M, Umezu H, Nishiyama T, Aoyama H, Tomita Y. Low-Dose-Rate and High-Dose-Rate Brachytherapy for Localized Prostate Cancer in ABO-Incompatible Renal Transplant Recipients. Transplant Proc 2019; 51:774-778. [DOI: 10.1016/j.transproceed.2018.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023]
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Outcomes in Organ Transplant Recipients With Prostate Cancer Treated With Radiotherapy. Clin Genitourin Cancer 2019; 17:e162-e166. [DOI: 10.1016/j.clgc.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/25/2018] [Accepted: 10/10/2018] [Indexed: 12/30/2022]
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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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Hevia V, Boissier R, Rodríguez-Faba Ó, Fraser-Taylor C, Hassan-Zakri R, Lledo E, Regele H, Buddde K, Figueiredo A, Olsburgh J, Breda A. Management of Localised Prostate Cancer in Kidney Transplant Patients: A Systematic Review from the EAU Guidelines on Renal Transplantation Panel. Eur Urol Focus 2018; 4:153-162. [DOI: 10.1016/j.euf.2018.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022]
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Pettenati C, Jannot AS, Hurel S, Verkarre V, Kreis H, Housset M, Legendre C, Méjean A, Timsit MO. Prostate cancer characteristics and outcome in renal transplant recipients: results from a contemporary single center study. Clin Transplant 2016; 30:964-71. [DOI: 10.1111/ctr.12773] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Caroline Pettenati
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Anne-Sophie Jannot
- Université Paris Descartes; Paris France
- Department of Statistics, Computing and Public Health; Hôpital européen Georges-Pompidou, AP-HP; Paris France
| | - Sophie Hurel
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Virginie Verkarre
- Université Paris Descartes; Paris France
- Department of Pathology; Hôpital Necker, AP-HP; Paris France
| | - Henri Kreis
- Université Paris Descartes; Paris France
- Department of Nephrology and Transplantation; Hôpital Necker, AP-HP; Paris France
| | - Martin Housset
- Université Paris Descartes; Paris France
- Department of Onco-Radiotherapy; Hôpital européen Georges-Pompidou, AP-HP; Paris France
| | - Christophe Legendre
- Université Paris Descartes; Paris France
- Department of Nephrology and Transplantation; Hôpital Necker, AP-HP; Paris France
| | - Arnaud Méjean
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Marc-Olivier Timsit
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
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Iizuka J, Hashimoto Y, Hashimoto Y, Kondo T, Takagi T, Nozaki T, Shimizu T, Akimoto T, Ishida H, Karasawa K, Tanabe K. Efficacy and Feasibility of Intensity-Modulated Radiation Therapy for Prostate Cancer in Renal Transplant Recipients. Transplant Proc 2016; 48:914-7. [DOI: 10.1016/j.transproceed.2016.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 01/20/2023]
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Rosenfelder N, Corbett R, Long M, Meehan C, Duncan N, Khoo V, Van As N. Intensity modulated radiation therapy allows prostate and dose-escalated pelvic radical radiation therapy after renal transplantation. Pract Radiat Oncol 2015; 5:e207-e213. [DOI: 10.1016/j.prro.2014.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/11/2014] [Accepted: 08/20/2014] [Indexed: 11/16/2022]
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Aboumohamed AA, Hemal AK. Should post-kidney transplant patients with localized prostate cancer be undergoing robotic radical prostatectomy? Int Urol Nephrol 2015; 47:643-4. [DOI: 10.1007/s11255-015-0929-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
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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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Khemees TA, Shabsigh A. Regaining candidacy for heart transplantation after robotic assisted laparoscopic radical prostatectomy in left ventricular assist device patient. Case Rep Transplant 2012; 2012:716201. [PMID: 23259138 PMCID: PMC3505944 DOI: 10.1155/2012/716201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/14/2012] [Indexed: 01/11/2023] Open
Abstract
Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD) therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.
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Affiliation(s)
- Tariq A. Khemees
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
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19
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Kahn S, Jani A, Edelman S, Rossi P, Godette K, Landry J, Anderson C. Matched Cohort Analysis of Outcomes of Definitive Radiotherapy for Prostate Cancer in Human Immunodeficiency Virus-Positive Patients. Int J Radiat Oncol Biol Phys 2012; 83:16-21. [DOI: 10.1016/j.ijrobp.2011.05.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/05/2011] [Accepted: 05/22/2011] [Indexed: 12/12/2022]
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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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21
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Detti B, Scoccianti S, Franceschini D, Villari D, Greto D, Cipressi S, Sardaro A, Zanassi M, Cai T, Biti G. Adjuvant Radiotherapy for a Prostate Cancer After Renal Transplantation and Review of the Literature. Jpn J Clin Oncol 2011; 41:1282-6. [PMID: 21940734 DOI: 10.1093/jjco/hyr133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Beatrice Detti
- Radiotherapy Unit, AOU Careggi, Viale Morgagni 85, 50144 Florence, Italy.
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22
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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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23
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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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24
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Elkentaoui H, Robert G, Pasticier G, Bernhard JC, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H. Therapeutic Management of De Novo Urological Malignancy in Renal Transplant Recipients: The Experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology 2010; 75:126-32. [PMID: 19864001 DOI: 10.1016/j.urology.2009.06.106] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/10/2009] [Accepted: 06/26/2009] [Indexed: 12/11/2022]
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25
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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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26
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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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Morbidity of Retropubic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Multicenter Study from Renal Transplantation Committee of French Urological Association. Urology 2008; 72:1366-70. [DOI: 10.1016/j.urology.2008.03.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/03/2008] [Accepted: 03/15/2008] [Indexed: 11/23/2022]
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28
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Pantanowitz L, Bohac G, Cooley TP, Aboulafia D, Dezube BJ. Human immunodeficiency virus-associated prostate cancer: clinicopathological findings and outcome in a multi-institutional study. BJU Int 2008; 101:1519-23. [PMID: 18384640 DOI: 10.1111/j.1464-410x.2008.07474.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize the clinicopathological findings and the outcome of human immunodeficiency virus (HIV)-infected patients diagnosed and treated for prostate carcinoma, as HIV-positive men being treated with highly active antiretroviral therapy (HAART) are living longer and thus are more likely to develop cancers such as prostate cancer. PATIENTS AND METHODS We performed a retrospective, multi-institutional study involving HIV-positive men with concomitant prostate carcinoma. We collected data regarding patient demographics (age, race), HIV status (CD4(+) cell count, HIV viral load, HAART), PSA level (at cancer diagnosis), symptoms and signs, radiological findings, pathology (Gleason score, stage), cancer treatment (type, side-effects), and outcome (response, survival). Accrued data was analysed using descriptive statistics. RESULTS We identified 17 patients (mean age 59 years) with HIV-associated prostate adenocarcinoma. The mean CD4(+) count was 336 cells/mm(3) and the mean HIV viral load was 17 319 copies/mL. In all, 14 (82%) of these men were receiving HAART. Most patients were diagnosed with carcinoma after an abnormal screening PSA level. The mean PSA level was 30 ng/mL. Only six (35%) men had an abnormal prostate on examination. The mean Gleason score was 6.8, and in most cases, cancer was confined to the prostate gland. Most patients were amenable to curative treatment with hormonal therapy, radiation, and/or prostatectomy. There were no serious treatment related side-effects. One patient remained untreated. All treated patients had a complete response (undetectable PSA level). Most patients were long-term survivors. Documented death in five cases was unrelated to prostate cancer. CONCLUSION The management of HIV-positive men with prostate carcinoma in the HAART era is becoming increasingly important. Our data shows that in men receiving HAART, their age, PSA levels, clinical presentation, management, and outcome from treated prostate carcinoma does not appear to be significantly altered by HIV status. Therefore, we recommend that patients with prostate cancer and well-controlled HIV viraemia be managed similarly to their HIV-negative counterparts.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
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29
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Kleinclauss F, Gigante M, Neuzillet Y, Mouzin M, Terrier N, Salomon L, Iborra F, Petit J, Cormier L, Lechevallier E. Prostate cancer in renal transplant recipients. Nephrol Dial Transplant 2008; 23:2374-80. [PMID: 18283085 DOI: 10.1093/ndt/gfn008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We conducted a retrospective multi-centre study to determine the characteristics of prostate cancer in renal transplant recipients (RTR) and to analyse the relation with immunosuppressive maintenance therapies. METHODS Patients from 19 French transplant centres diagnosed with prostate cancer at least 1 year after kidney transplantation were included in this study. Data regarding demographics, kidney transplantation, prostate cancer and immunosuppressive treatment were analysed. RESULTS Sixty-two patients met the eligibility criteria for this study. Thirty-eight patients (61.3%) received calcineurin inhibitors (CNI) and azathioprine (AZA) with or without steroids, twenty received CNI with or without steroids (32.2%) and four received CNI and mycophenolate mofetil (6.5%). Patients with CNI and AZA immunosuppressive therapy presented more high-stage cancer (T3 and T4) when compared to patients receiving CNI alone (47.5% versus 15%, respectively, P = 0.03). A non-significant increase in lymph node invasion was found in patients receiving CNI and AZA compared to patients receiving CNI alone (21% versus 5%, P = 0.16). In the multivariate analysis, the immunosuppressive regimen with CNI and AZA was the only independent risk factor for locally advanced disease (P = 0.007). CONCLUSION Our results showed that RTR are at risk for early occurrence and for locally advanced prostate cancer, especially when they received a CNI and AZA maintenance immunosuppressive therapy.
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Affiliation(s)
- François Kleinclauss
- Renal Transplantation Committee of the French Urological Association, Paris, France.
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Abstract
OBJECTIVES The aim of the study was to determine the rate of, and factors associated with, elevated prostate-specific antigen (PSA) levels in older men with or at risk of HIV infection. METHODS Using a cross-sectional analysis, we interviewed 534 men > or =49 years old at risk for HIV infection on demographics, behaviours and medical history. Laboratory testing included serum PSA level and HIV serology, and T-cell subsets for those who were HIV seropositive. Elevated PSA level was defined as >4.0 ng/mL, and men with elevated PSA levels were referred for urological evaluation. RESULTS Fifteen per cent of men were white, 55% black, and 23% Hispanic; median age was 53 years (range 49-80 years); 74% were sexually active; 65% currently smoked cigarettes; and 16% had taken androgens. Among 310 HIV-positive men, CD4 counts were >500 cells/microL in 31%, 200-500 cells/microL in 51%, and <200 cells/microL in 19%. Twenty men (4%) had elevated PSA. On univariate analysis, only older age was significantly associated with elevated PSA, and there was no significant difference in the number of men with elevated PSA between HIV-positive and HIV-negative men (nine of 310 vs 11 of 224; P = 0.28). On multivariate analysis, older age remained the only variable associated with elevated PSA level [reference group < or =50 years; adjusted odds ratio (OR(adj)) 1.0 for age 51-60 years; OR(adj) 5.9 (95% confidence interval 1.2-30.1) for age > or =61 years] adjusted for HIV status, family history of prostate cancer, and androgen use. CONCLUSIONS Among older men, PSA levels increased with age but did not differ by HIV status. The clinical use of PSA levels in older men currently do not need to be modified for those with HIV infection.
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Affiliation(s)
- L E Vianna
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
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31
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Abstract
Malignancy is a recognized complication of transplantation. Genitourinary cancers are the second most common tumors in transplant recipients with prostate cancer and renal cell carcinoma the most common. Unlike the more common skin malignancies, genitourinary tumors have a significant impact on both graft and patient survival. Surgical and radiation treatments need to consider the location of heterotopic transplants and administration of chemotherapy may need alteration in light of immunosuppression being used. The major genitourinary malignancies and their management will be reviewed in this article with emphasis on the concerns that arise in a transplant recipient.
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Affiliation(s)
- Nicolas A Muruve
- Department of Urology and Kidney Transplantation, Cleveland Clinic Florida, Weston, FL 33332, USA.
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Mohammadi S, Silvaggio G, Bonnet N, Berberian G, Dorent R, Bikter M, Pavie A, Gandjbakhch I. Prostate Cancer After Heart Transplantation: Unicenter Case-Control Study. J Heart Lung Transplant 2005; 24:995-7. [PMID: 16102432 DOI: 10.1016/j.healun.2004.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 06/08/2004] [Accepted: 06/19/2004] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We have noted an unexpectedly high incidence of prostate cancer in our heart transplant recipients (HTR). METHODS We conducted a retrospective review of patients after heart transplantation to investigate the prevalence, treatment, and outcome of prostate cancer diagnosed after systematic screening (study group). We compared them with case-matched HTR (control). RESULTS Among 702 recipients, 15 patients had elevated prostate-specific antigen (PSA) levels. Fourteen cases of prostate cancer were diagnosed and treated. The median time between transplantation and prostate cancer diagnosis was 73 months. No patient was diagnosed in a locally advanced (>T2) or metastatic stage. Eleven patients (78.6%) received curative treatment. During follow-up (median, 44 months), 1 patient died from prostate cancer. The survival rate between the study and control groups did not differ. CONCLUSION Routine PSA testing is recommended as a screening test for prostate cancer in patients after heart transplantation. We believe this could also result in detection of early stages of prostate cancer, thus allowing curative treatment, and achieving similar survival to other case-matched HTR with no prostate cancer.
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Affiliation(s)
- Siamak Mohammadi
- Institute of Cardiology, Thoracic and Cardiovascular Surgery Department, La Pitié Hospital, Paris, France.
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Abstract
OBJECTIVE To investigate the feasibility of perineal radical prostatectomy (RP) in renal transplant recipients with localized prostate cancer. PATIENTS AND METHODS The study comprised seven consecutive renal transplant patients who had a perineal RP between May 1991 and February 2004. All available clinicopathological data were reviewed. Results All seven patients successfully tolerated RP with no major complications. The mean (sd, range) age at surgery was 62.3 (2.5, 55-74) years and the mean interval from renal transplant to RP 86.5 (25.25, 24-192) months. There was no evidence of increased blood loss, operative duration, transfusion requirement, hospital stay or deterioration of graft function. The presence of an allograft did not alter the surgical approach or management of the patients after RP. The mean follow-up was 22 (2-130) months and all seven patients were followed. One patient had evidence of biochemical recurrence with no radiographic evidence of metastatic disease. Serum prostate-specific antigen was undetectable in the remaining patients. CONCLUSION A perineal RP in renal transplant recipients for treating localized prostate cancer offers many advantages over other treatments.
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Affiliation(s)
- Jason Hafron
- Department of Urology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
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Lledó García E, Jara Rascón J, Díez Cordero JM, Subirá Ríos D, Alvarado A, Fernández de Lomana FA, Hernández Fernández C. Tratamiento de adenocarcinoma prostático localizado en paciente con trasplante renal mediante Ultrasonido de Alta Intensidad. Actas Urol Esp 2005; 29:70-3. [PMID: 15786766 DOI: 10.1016/s0210-4806(05)73200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a 62 years old kidney transplant (KT) patient who was diagnosed of localized prostatic cancer (PC) after 6 years of the implant. Transrectal prostatic High Intensity Focused Ultrasound (HIFU) was applied. Results have been satisfactory, achieving pathologic and biochemical success. The discharge was completed at 24 hs, the morbidity was minimal. We have not found any reference in the literature on the appliance of HIFU in PC KT patients. We think that HIFU may represent a good alternative for these patients.
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Affiliation(s)
- E Lledó García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid
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35
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Bayne A, Barry JM, Garzotto M. Radical retropubic prostatectomy after orthotopic liver transplantation. Urology 2005; 65:175. [PMID: 15667896 DOI: 10.1016/j.urology.2004.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 08/10/2004] [Indexed: 11/20/2022]
Abstract
Radical prostatectomy is a standard treatment option for many patients with clinically localized prostate cancer; however, little information about its safety and efficacy is available to help guide patients who have undergone prior organ transplantation. We present 2 cases of patients with prior hepatic transplantation who each subsequently underwent radical prostatectomy. In each case, the prostate tumor was organ confined, and both patients were biochemically free of disease at last follow-up.
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Affiliation(s)
- Aaron Bayne
- Division of Urology and Renal Transplantation, Oregon Health and Science University, Portland, Oregon, USA
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36
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Tratamiento de adenocarcinoma prostático localizado en paciente con trasplante renal mediante Ultrasonido de Alta Intensidad. Actas Urol Esp 2005. [DOI: 10.1016/s0210-4806(05)73199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Renal transplantation is the best available therapy for patients with end-stage renal failure. Urologists are often consulted regarding pretransplant evaluation and treatment of potential renal transplant recipients. Frequently the urologist is the primary surgeon in the transplant unit. This review highlights the importance of performing a comprehensive urological assessment before renal transplantation. A retrospective review of the urological and transplant literature using Medline was performed from 1976 to 2002, searching for renal transplantation and its association with urological cancers and urinary tract malformations. The pretransplant urological assessment aims to diagnose, treat, and optimize any preexisting urological disease. On occasion, certain urological diseases may not be obvious or may not have contributed to the progression to end-stage renal failure such as occult urinary tract neoplasms, urinary calculus disease, or benign prostatic hyperplasia. A thorough evaluation of the urinary tract prior to renal transplantation is mandatory to avoid unforeseen problems occurring posttransplant. If this assessment is consistently adhered to, only in very rare circumstances does a potential recipient have to be denied the opportunity of receiving an allograft based on a preexisting urological disease.
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Affiliation(s)
- R E Power
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
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38
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Mouzin M, Bachaud JM, Kamar N, Gamé X, Vaessen C, Rischmann P, Rostaing L, Malavaud B. Three-Dimensional Conformal Radiotherapy for Localized Prostate Cancer in Kidney Transplant Recipients. Transplantation 2004; 78:1496-500. [PMID: 15599314 DOI: 10.1097/01.tp.0000137933.97259.e7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This is the first report of graft function and prostate cancer control in renal transplant recipients subjected to modern conformal radiotherapy. METHODS Eight kidney transplant recipients were treated with three-dimensional conformal radiotherapy. All patients but one were subjected to transitory hormonal deprivation. A three-dimensional radiotherapy-planning system (Pinnacle, Philips Medical System, Bothell, WA) was used to delineate anatomic contours on pretreatment computed tomography and for dose computation. The clinical target volume encompassed the prostate and was expanded with a 10-mm wide margin in all directions to obtain the planning target volume. The irradiation technique consisted of a nine-field arrangement delivering 70 Gy in 2-Gy fractions, with 18-MV photon beams. Biochemical recurrence was defined as two consecutive increases in prostate-specific antigen (>1.5 ng/mL). Graft function was monitored by creatinine clearance. Excretory profiles were assessed by furosemide-stimulated diethylenetriaminepentaacetic acid renography. All patients were subjected to hip magnetic resonance imaging to assess for avascular hip necrosis. RESULTS After a mean follow-up of 28 months, two patients showed isolated biochemical recurrence and six patients remained free of recurrence. In seven patients with functional allografts, the creatinine clearance was unimpaired by treatment. However, significant obstruction of the terminal ureter was revealed in two patients by furosemide-stimulated diethylenetriaminepentaacetic acid renograms. The doses delivered to the uretero-neocystostomy were calculated to range from less than 20 Gy to more than 45 Gy depending on bladder repletion. CONCLUSIONS Adequate cancer control was achieved at the expense of infraclinical ureteral obstruction. The doses delivered to the uretero-neocystostomy may be reduced by having a full bladder at the time of irradiation. No avascular hip necrosis was observed.
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Affiliation(s)
- Marc Mouzin
- Department of Urology and Renal Transplantation, Hopital Rangueil 1, Avenue J. Poulhes, 31403 Toulouse Cedex 2, France
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Cormier L, Lechevallier E, Barrou B, Benoit G, Bensadoun H, Boudjema K, Descottes JL, Doré B, Guy L, Malavaud B, Martin X, Patard JJ, Petit J, Salomon L. Diagnosis and treatment of prostate cancers in renal-transplant recipients. Transplantation 2003; 75:237-9. [PMID: 12548131 DOI: 10.1097/01.tp.0000041785.38998.6c] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no consensus regarding prostate cancer in renal-transplant recipients (RTR). A questionnaire evaluating prostate cancer screening after transplantation and assessing the number, diagnostic modalities, treatment, and outcome of prostate cancer cases was mailed to 22 French renal-transplant centers. RESULTS Among 1,680 RTR in 1998, 11 (0.65%) cases of prostate cancer were diagnosed, and among the 2,338 recipients followed up, 28 (1%) cases of prostate cancer have been diagnosed and treated. Median ages at diagnosis and at transplantation were 63 and 58, respectively. Clinical stages were T1 50% and T2 25%. Eighteen patients had a Gleason score under 7. At 18 months of mean follow-up, 2 men had died from prostate cancer, and in the curative treatment group, 16 of 17 men were alive with no evidence of disease. CONCLUSIONS The incidence of prostate cancer in RTR appeared to be higher than expected. Prostate specific antigen (PSA) testing should be performed routinely each year in renal transplantation centers.
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Affiliation(s)
- Luc Cormier
- Renal Transplantation Committee of the French Urological Association, Paris, France
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40
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Burgos FJ, Alcaraz A, Castillón I, González Martín M, Lledó E, Matesanz R, Marcén R, Montañés P, Pascual J. [Present and future of kidney transplantation]. Actas Urol Esp 2002; 26:731-58. [PMID: 12645371 DOI: 10.1016/s0210-4806(02)72853-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal transplant is the treatment of choice for the patient with end stage renal disease. Spain is the country with the highest donation rate (33 ppm). However, at present this figure is stabilized. The development of non-beating heart programmes, living-donor nephrectomy (specially laparoscopic nephrectomy) programmes, and may be xenotransplantation in a non-immediate future could increase the transplantation activity. The knowledge of preservation mechanisms, specially with the use of perfusion machines allows to rescue for transplantation kidneys with a long warm-ischemia time. Furthermore, these machines are useful for analyzing viability markers. The new immunosuppressive drugs: Tacrolimus, Mycophenolate-Mophetil, Rapamycin and monoclonal antibodies against alpha chain of the interleukine-2 receptor (Basoliximab and Dazcizumab) have reduced the incidence of acute rejection in the immediate renal transplant period. However, its effect in the long-term follow-up period is still a matter of controversy. The incidence of tumour in the renal transplant recipient is increased, specially those of lymphoma, skin cancer and Kaposi sarcoma. Periodical exams for detecting the development of tumours are mandatory in this population. Finally, xenotransplantation is an attractive alternative, although immunological, infective and ethical barriers should previously be resolved.
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Affiliation(s)
- F J Burgos
- Servicio de Urología, Hospital Ramón y Cajal, Universidad Alcalá, Madrid
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Lechevallier E, Cormier L, Barrou B, Benoit G, Bensadoun H, Boudjema K, Descottes JL, Doré B, Guy L, Malavaud B, Martin X, Petit J, Salomon L. Prostate cancer in renal transplant recipients. Transplant Proc 2002; 34:722. [PMID: 12009678 DOI: 10.1016/s0041-1345(02)02624-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Eric Lechevallier
- Renal Transplantation Committee of the French Urological Association, Hôpital Salvador, 249 Boulevard Sainte Marguerite, 13274 Marseille, France.
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Kasiske BL, Vazquez MA, Harmon WE, Brown RS, Danovitch GM, Gaston RS, Roth D, Scandling JD, Singer GG. Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation. J Am Soc Nephrol 2001. [PMID: 11044969 DOI: 10.1681/asn.v11suppl_1s1] [Citation(s) in RCA: 392] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Many complications after renal transplantation can be prevented if they are detected early. Guidelines have been developed for the prevention of diseases in the general population, but there are no comprehensive guidelines for the prevention of diseases and complications after renal transplantation. Therefore, the Clinical Practice Guidelines Committee of the American Society of Transplantation developed these guidelines to help physicians and other health care workers provide optimal care for renal transplant recipients. The guidelines are also intended to indirectly help patients receive the access to care that they need to ensure long-term allograft survival, by attempting to systematically define what that care encompasses. The guidelines are applicable to all adult and pediatric renal transplant recipients, and they cover the outpatient screening for and prevention of diseases and complications that commonly occur after renal transplantation. They do not cover the diagnosis and treatment of diseases and complications after they become manifest, and they do not cover the pretransplant evaluation of renal transplant candidates. The guidelines are comprehensive, but they do not pretend to cover every aspect of care. As much as possible, the guidelines are evidence-based, and each recommendation has been given a subjective grade to indicate the strength of evidence that supports the recommendation. It is hoped that these guidelines will provide a framework for additional discussion and research that will improve the care of renal transplant recipients.
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Affiliation(s)
- B L Kasiske
- Division of Nephrology, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415, USA.
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Malavaud B, Hoff M, Miédouge M, Rostaing L. PSA-based screening for prostate cancer after renal transplantation. Transplantation 2000; 69:2461-2. [PMID: 10868663 DOI: 10.1097/00007890-200006150-00047] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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