Prostate cancer in kidney transplant recipients – a nationwide register study

Abstract

ConclusionsThis Swedish nationwide, register-based study gave no indication that immunosuppression after kidney transplantation increases the risk of prostate cancer or adversely affects prostate cancer outcomes. The study suggests that men with untreated low-grade prostate cancer can be accepted for transplantation.

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

“…Given this background, the utility of PCa screening, performed in all candidates to renal transplantation to ensure appropriate kidney allocation, remains still debated. Bratt et al in their national renal register and PCa register identified 133 KT recipients, transplantated before 1990s when PSA testing became common, and concluded their analysis that immunosuppression after KT did not increase the risk of PCa or adversely affected PCa outcomes ( 30 ). In our study, PCa incidence for RTRs was 3.24%, slightly higher when compared to previously published reports where incidence ranged from 0.3 to 2% ( 7 , 31 ).…”

Urological Cancers and Kidney Transplantation: a Literature Review

“…The mammalian target of rapamycin (mTOR) inhibitor, sirolimus, has been associated with lower risk of malignancy (HR 0.60, 95% CI 0.39-0.93) with an even greater reduction in patients switching from other regimens to sirolimus [13]. In a recent study, Bratt and colleagues demonstrated that immunosuppressive therapy did not increase the overall risk of PCa in RTRs [14].…”

Prostate cancer and kidney transplantation – exclusion or co‐existence?

“…To summarise, this study [1], and others before that, suggests that immunosuppression after kidney transplantation is unlikely to adversely affect prostate cancer initiation or progression. Men with low‐risk prostate cancer should be considered for transplantation without first undergoing definitive therapy.…”

“…The basis for this approach stems from the theoretical higher risk of disease progression and ultimately mortality on immunosuppression. In this issue of the BJU International , Bratt et al [1] challenge these assumptions and report on the outcomes of kidney transplant recipients diagnosed with prostate cancer. First, they found no difference in prostate cancer incidence, suggesting that transplant recipients, despite being immunosuppressed, are not at higher risk of prostate cancer.…”

“…Hypothesising that many of the transplant recipients in this study already had prostate cancer when they underwent transplantation (based on assumptions about cancer screening practices in Sweden and the time periods included), the authors aim to refute current transplantation guidelines contraindicating solid organ transplantation in those with a history of prostate cancer and requiring a minimum recurrence‐free period before placing these patients on the organ waiting list [2,3]. The findings of Bratt et al [1] corroborate previous case series including the largest study of cancer incidence among transplant recipients and a meta‐analysis of six studies. Given the available data, is it still justifiable to deny patients with low‐risk prostate cancer life‐saving kidney transplantation?…”