Prostate Cancer Screening and Treatment in the Transplant Population: Current Status and Recommendations

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.

Key Words: prostate-specific antigen, prostatic neoplasms, transplantation, graft survival

Abbreviations and Acronyms: cPSA, complexed PSA, ESLD, end stage liver disease, ESRD, end stage renal disease, fPSA, free PSA, HD, hemodialysis, MMF, mycophenolate mofetil, PSA, prostate specific antigen, tPSA, total PSA