Radiotherapy in prostate cancer after kidney transplant in 6 cases

Abstract

Background: Patients who received a kidney transplant (KT) are described in literature as a group with a higher incidence of malignant neoplasms compared to the general population. Cancer development after KT has become a major issue, as a remarkable percentage of patients are diagnosed with cancer. Treatment of prostate cancer (PCa) in renal transplant recipients (RTRs) is a challenging issue that has been discussed by many authors over the years, but evidence is sparse and often includes conflicting reports. Among the therapeutic options for PCa in these patients, prostate irradiation represents a valuable alternative to surgery or other systemic therapies, as RTRs are often ineligible for these treatments. Objective: To report six cases treated at our institution between 1998 and 2017 and discuss the available literature. Methods: Patients’ characteristics were reported along with biochemical status at diagnosis, type of immunosuppressive treatment, radiation therapy technique, and dose to transplanted kidney. Results: Overall, prostate irradiation was delivered respecting the dose constraints and patients showed good tolerance with no reports of acute or late transplanted kidney injury. Conclusions: Our experience confirms that prostate radiotherapy for RTRs is feasible and effective and represents a valid option that should be considered by the multidisciplinary team.

The role of localised prostate cancer treatment in renal transplant patients: A systematic review

“…The prostate cancer‐specific survival at 1 and 3 years was 100% and 99% (Figure 3A,B). The prostate cancer deaths were in high‐risk Gleason 8 prostate cancer patients 3,26,54,60 . Subgroup analysis by Gleason grading again was unable to be performed because of the lack of clear reporting in the included studies.…”

“…The majority of complications were minor grade 1 cystitis and proctitis. There was one major complication—one patient who had a grade 3 proctitis requiring a diverting colostomy 60 …”

“…There was one major complication—one patient who had a grade 3 proctitis requiring a diverting colostomy. 60 …”

“…Serious complications (Clavien Dindo Grade 3 or higher) occurred in 6% of surgery patients with no perioperative deaths recorded. The radiation complications were mainly related to cystitis and proctitis with the most severe case being a patient with Gleason 6 prostate cancer who underwent EBRT and developed colitis requiring a diverting colostomy 60 …”

“…There was one major complication-one patient who had a grade 3 proctitis requiring a diverting colostomy. 60 3.12 | Radiotherapy pre-transplant Overall, there were two studies that examined radiotherapy treatment for prostate cancer before renal transplantation. 67,69 There were a total of seven patients with a mean age of 63.5 and PSA of 6.7.…”