Incidence, Management, and Clinical Outcomes of Prostate Cancer in Kidney Transplant Recipients.

Abstract

We reviewed the incidence, management, and survival outcomes of prostate cancer among kidney transplant recipients and compared these characteristics with a national population (nonrecipients). A retrospective study was performed on all kidney transplant recipients from a National Kidney Transplant Centre who were subsequently diagnosed with prostate cancer. Primary outcome variables included comparisons of incidence and 5-year overall survival in kidney transplant recipients versus nonrecipients after treatment of prostate cancer. Secondary outcome variables were prostate-specific antigen levels at diagnosis, Gleason grade, treatment strategy, and morbidity from treatment among kidney transplant recipients. Of 4048 kidney transplants performed, 3020 were male recipients (63.9%). In total, 34 kidney transplant recipients (1.1%) were diagnosed with prostate cancer 109 ± 83 months (range, 7-372 mo) after transplant. The mean age at prostate cancer diagnosis was 64 ± 7 years, median prostate-specific antigen level was 10 ng/dL (range, 2.6-771 ng/dL), and 76% (n = 26/34) were diagnosed with localized disease. The incidence of prostate cancer was 1126/100 000 in kidney transplant recipients compared with 160/100 000 nonrecipients in Ireland (P = .01). Treatment strategies included curative radiotherapy (n = 18), curative surgery (n = 2), androgen deprivation therapy (n = 8), and watchful waiting (n = 6). Overall survival rates at 1, 3, and 5 years were not significantly different between kidney transplant recipients with prostate cancer versus nonrecipients with prostate cancer (98% vs 98%, 80% vs 79%, and 77% vs 72%, respectively, P = .8). The incidence of prostate cancer is significantly higher among kidney transplant recipients compared with nonrecipients in the general population, with most diagnosed with localized disease. Definitive management guidelines should be developed to increase awareness and optimize treatment options in this unique patient cohort.