Prostate Cancer Characteristics in Renal Transplant Recipients: A 25-Year Experience From a Single Centre

Pietro Spatafora,Graziano Vignolini,Giulio Nicita,Donata Villari,Gabriella Nesi,Maria Zanazzi,Sergio Serni,Calogero Saieva,Simone Caroassai Grisanti,Francesco Sessa,Lorenzo Verdelli,Claudio Bisegna,Anna Rivetti,Paolo Polverino,Giandomenico Roviello,Detti Beatrice

doi:10.3389/fsurg.2021.716861

Abstract

Objectives: The incidence of prostate cancer in renal transplant recipients (RTRs) is increasing, but few data are available in the literature. In this study, we reviewed the 25-year experience in the management of prostate cancer after kidney transplantation at the Florence Transplant Centre.Methods: We retrospectively reviewed the data from 617 RTR male patients who underwent renal transplantation at our institute between July 1996 and September 2016. Data regarding demographics, renal transplantation, prostate cancer and immunosuppressive treatment were analyzed. The probability of death was estimated by using the Kaplan-Meier method and differences between patients' groups were assessed by the log-rank test.Results: From July 1991 to September 2016, 617 kidney transplantations of male patients were performed at our institute. Among these, 20 patients were subsequently diagnosed with prostate cancer accounting for a cumulative incidence of 3.24%. After a median follow-up of 59 months, 10 patients underwent radical prostatectomy whereas 10 patients underwent primary radiotherapy. A biochemical recurrence was identified in five (25%) patients while a fatal event occurred in 11 (55%) patients. Univariate Cox regression showed that the basal value of PSA >10 ng/ml was the only significant factor negatively affecting the survival of patients.Conclusions: Standard treatments can be proposed to RTR with satisfactory results on both post-operative and oncological outcomes. Further studies are needed to address the issue of prostate cancer screening based on PSA levels and the optimal management of prostate cancer in RTRs.

Highlights

Kidney transplantation is considered the standard of care for patients with end-stage kidney disease under chronic dialysis treatment [1]
We retrospectively reviewed data from all male patients who underwent renal transplantation at our institute between July 1991 and September 2016, identifying those who developed Prostate cancer (PCa) during the scheduled follow-up
All patients were on immunosuppressive therapy (IS) maintenance, according to our standard protocol: double IS was administered to 4 patients based on calcineurin inhibitors (CNI) and steroids; triple IS was administered in association with Azathioprine (AZA) to three patients, in association with Mycophenolate Mofetil (MMF) to 12 patients and in association with mTOR inhibitors (Everolimus) to one patient

Summary

Introduction

Kidney transplantation is considered the standard of care for patients with end-stage kidney disease under chronic dialysis treatment [1]. The development of cancer has become a major concern as it is currently one of the main causes of death in RTRs. The increasing incidence of post-transplant malignancies is generally attributed to immunosuppression which leads to impaired immunosurveillance of cancer cells and viral infections capable of cancer development. The increasing incidence of post-transplant malignancies is generally attributed to immunosuppression which leads to impaired immunosurveillance of cancer cells and viral infections capable of cancer development It has been observed a direct and specific pro-oncogenic effect on RTRs of immunosuppressive drugs [5, 6] and other immunosuppressionindependent factors such as the increased age of RTRs, the male gender and the pre-transplant dialysis duration [7, 8]

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Results

Conclusion