MP79-03 WAG THE DOG?: PSA SCREENING IN KIDNEY TRANSPLANT CANDIDATES

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-03 WAG THE DOG?: PSA SCREENING IN KIDNEY TRANSPLANT CANDIDATES Daniel Canter, Gerardo Vitiello, Blayne Sayed, Ken Ogan, and Nicole Turgeon Daniel CanterDaniel Canter More articles by this author , Gerardo VitielloGerardo Vitiello More articles by this author , Blayne SayedBlayne Sayed More articles by this author , Ken OganKen Ogan More articles by this author , and Nicole TurgeonNicole Turgeon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2860AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Screening recommendations for prostate cancer (PC) in the general population are controversial due to the low sensitivity of prostate-specific antigen (PSA) as a marker for PC as well as the indolent nature of PC. The current study aims to determine whether the use of PSA screening in men being evaluated for renal transplantation either delays the time to listing or time to kidney transplantation as well as whether the diagnosis of PC effects the rate of transplantation and graft/patient survival. METHODS A single center retrospective analysis of 3737 patients undergoing kidney transplant evaluation from January 1, 2001 to January 1, 2011 was performed. Men were categorized according to the following American Urological Association (AUA) PSA screening guideline recommendations: Group 1: <55 y.o., Group 2: 55-69 y.o. and Group 3: >69 y.o. Univariate analysis and Cox Proportional Hazards (CPH) identified the independent effect of PSA screening on transplant times. Kaplan Meier survival curves examined the effects of PSA screening and PC on overall patient and graft survivals. RESULTS In total, 1135 patients received kidney transplants (30.4%). PSA screening was performed in 53.9% of Group 1, 81.1% of Group 2, and 83.8% of Group 3. In group 2, the time to transplant was significantly longer in patients having a PSA >4 versus those having a PSA <4 (1355 vs. 853 days; p<0.001). Men with a screening PSA > 4 who never developed prostate cancer were less likely to receive transplants than those patients with a positive screen who develop prostate cancer (18.5 versus 40%, p=0.0025). PC was confirmed in 27% of patients with a PSA >4, and only 24.3% of patients with a PSA >4 received transplants. PSA screening did not impact overall patient survival or graft survivals, though a diagnosis of prostate cancer significantly reduced overall patient survival (HR 2.19 [1.04-4.59]; p=0.0038). CONCLUSIONS A PSA screening level >4 may lower the likelihood of receiving a kidney transplant, however, our data indicate that PSA screening has no effect on overall patient survival. Proper patient selection for PSA screening is essential as delayed transplant times in patients with end-stage renal disease (ESRD) leads to reduced quality of life as well as increase patients' risk of medical and cardiovascular complications while awaiting transplantation. The routine use of PSA screening in renal transplant candidates should reflect a consideration of these risks compared to the biologic phenotype of PC. At the very least, PC screening in the renal transplant population should be more in line with recent recommendations for the general population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1011 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Canter More articles by this author Gerardo Vitiello More articles by this author Blayne Sayed More articles by this author Ken Ogan More articles by this author Nicole Turgeon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...