Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series

Marra, Giancarlo; Agnello, Marco; Giordano, Andrea; Soria, Francesco; Oderda, Marco; Dariane, C.; Timsit, Marc‐Olivier; Brancherau, Julien; Hedli, Oussama; Mesnard, B.; Tilki, Derya; Olsburgh, Jonathon; Kulkarni, Meghana; Kasivisvanathan, Veeru; Breda, Alberto; Biancone, Luigi

doi:10.1016/j.eururo.2022.05.024

Cited by 9 publications

(21 citation statements)

References 22 publications

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“…The surgical complication rate was 14.5% with the vast majority of these being minor (Clavien Dindo Classification Grade 2 or less). Major complications included rectal injury and rectourethral fistula requiring colostomy, 17 postoperative lymphocoele requiring percutaneous drainage or marsupialisation, 15,27,50 postoperative bleeding requiring pelvic vessel angioembolisation 53 and pelvic abscess requiring open drainage 48 . The renal graft‐specific complication rate was 3% with the main cause being transplant ureteric injury during dissection 15,27 .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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ObjectiveTo systematically review and critically appraise all treatment options for localised prostate cancer in renal transplant candidates and recipients.MethodA systematic review was conducted adhering to PRISMA guidelines. Searches were performed in the Cochrane Library, Embase, Medline, the Transplant Library and Trip database for studies published up to September 2022. Risk of bias was assessed with the Cochrane Risk of Bias in Non‐Randomised Studies of Interventions for non‐randomised studies tool.ResultsA total of 60 studies were identified describing 525 patients. The majority of studies were either retrospective non‐randomised comparative or case series/reports of poor quality. The vast majority of studies were focussed on prostate cancer after renal transplantation. Overall, 410 (78%) patients underwent surgery, 93 (18%) patients underwent radiation therapy or brachytherapy, one patient underwent focal therapy (high‐intensity frequency ultrasound) and 21 patients were placed on active surveillance. The mean age was 61 years old, the mean PSA level at diagnosis was 9.6 ng/mL and the mean follow‐up time was 31 months. The majority of patients had low‐risk disease with 261 patients having Gleason 6 prostate cancer (50%), followed by 220 Gleason 7 patients (42%). All prostate cancer mortality cases were in high‐risk prostate cancer (≥Gleason 8). The cancer‐specific survival results were similar between surgery and radiotherapy at 1 and 3 years.ConclusionLocalised prostate cancer treatment in renal transplant patients should be risk stratified. Surgery and radiation treatment for localised prostate cancer in renal transplant patients appear equally efficacious. Given the limitations of this study, future research should concentrate on developing a multicentre RCT with long‐term registry follow‐up.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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“…Currently, no major increase in complications has been detailed overall in RTR when surgery for PCa is performed in tertiary referral centres [ 2 ]. Nonetheless, performing RARP may be more challenging compared to non-RTR and requires technical modifications to the standard technique [ 8 ]. Therefore, selection of RTR for surgical treatment of PCa should be done carefully.…”

Section: Discussionmentioning

confidence: 99%

Active surveillance in renal transplant patients with prostate cancer: a multicentre analysis

et al. 2023

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Introduction Due to medical improvements leading to increased life expectancy after renal transplantation and widened eligibility criteria allowing older patients to be transplanted, incidence of (low-risk) prostate cancer (PCa) is increasing among renal transplant recipients (RTR). It remains to be established whether active surveillance (AS) for PCa represents a safe treatment option in this setting. Therefore, we aim to compare AS discontinuation and oncological outcomes of AS for PCa of RTR vs. non-transplant patients. Methods Multicentre study including RTR diagnosed with PCa between 2008 and 2018 in whom AS was initiated. A subgroup of non-RTR from the St. Antonius hospital AS cohort was used as a control group. Comparison of RTR vs. non-RTR was performed by 2:1 propensity score matched survival analysis. Outcome measures included tumour progression-free survival, treatment-free survival, metastasis rates, biochemical recurrence rates and overall survival. Patients were matched based on age, year of diagnosis, PSA, biopsy ISUP grade group, relative number of positive biopsy cores and clinical stage. Results A total of 628 patients under AS were evaluated, including 17 RTRs and 611 non-RTRs. A total of 13 RTR cases were matched with 24 non-RTR cases. Median overall follow-up for the RTR and non-RTR matched cases was, respectively, 5.1 (IQR 3.2–8.7) years and 5.7 (IQR 4.8–8.1) years. There were no events of metastasis and biochemical recurrence among matched cases. The matched-pair analysis results in a 1-year and 5-year survival of the RTR and non-RTR patients were, respectively, 100 vs. 92%, and 39 vs. 76% for tumour progression, 100 vs. 91% and 59 vs. 76% for treatment-free survival and, respectively, 100 vs. 100% and 88 vs. 100% for overall survival. No significant differences in tumour progression-free survival (p = 0.07) and treatment-free survival were observed (p = 0.3). However, there was a significant difference in overall survival comparing both groups (p = 0.046). Conclusions AS may be carefully considered in RTR with low-risk PCa. In our preliminary analysis, no major differences were present in AS outcomes between RTR and non-RTR. Overall mortality was significantly higher in the RTR subgroup.

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“…In fact, some studies have shown that in RARP, EBL may be much less than 200 mL [87,93,94]. In a contemporary series of patients treated with RARP by Marra et al [90], no complications scored as Clavien 4 or 5 were recorded. The authors point out that, similarly to the open-approach series [86], the most common complications remain infections.…”

Section: Functional Outcomes and Complications Following Radical Trea...mentioning

confidence: 97%

“…The majority of the series was, however, carried out on patients treated with a robotic approach. The mean estimated blood loss (EBL) in open surgery seems to be higher than in RARP (404 vs. 300 mL) [63,90]. In fact, some studies have shown that in RARP, EBL may be much less than 200 mL [87,93,94].…”

Section: Functional Outcomes and Complications Following Radical Trea...mentioning

confidence: 99%

“…The choice of approach (minimally invasive vs. open) is currently an issue of shifting dogma. It has been suggested that laparoscopic radical prostatectomy in RTRs might bear an increased risk of rectal injury due to technical difficulties [70], although, no need for temporal colostomy or fistula was recorded in the available series [90][91][92]. The majority of the series was, however, carried out on patients treated with a robotic approach.…”

Section: Functional Outcomes and Complications Following Radical Trea...mentioning

confidence: 99%

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Prostate Cancer in Transplant Receivers—A Narrative Review on Oncological Outcomes

Hanusz,

Domański,

Strojec

et al. 2023

Biomedicines

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Prostate cancer (PCa) is a low tumor mutational burden (TMB) cancer with a poor response to immunotherapy. Nonetheless, immunotherapy can be useful, especially in metastatic castration-resistant PCa (mCRPC). Increased cytotoxic T lymphocytes (CTLs) density is correlated with a shorter overall survival (OS), an early biochemical relapse, and a generally poor PCa prognosis. An increased number of CCR4+ regulatory T cells (CCR4 + Tregs) relates to a higher Gleason score or earlier progression. The same therapeutic options are available for renal transplant recipients (RTRs) as for the population, with a comparable functional and oncological outcome. Radical retropubic prostatectomy (RRP) is the most common method of radical treatment in RTRs. Brachytherapy and robot-assisted radical prostatectomy (RARP) seem to be promising therapies. Further studies are needed to assess the need for prostatectomy in low-risk patients before transplantation. The rate of adverse pathological features in RTRs does not seem to differ from those observed in the non-transplant population and the achieved cancer control seems comparable. The association between PCa and transplantation is not entirely clear. Some researchers indicate a possible association between a more frequent occurrence of PCa and a worse prognosis in advanced or metastatic PCa. However, others claim that the risk and survival prognosis is comparable to the non-transplant population.

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Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series

Cited by 9 publications

References 22 publications

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

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

Active surveillance in renal transplant patients with prostate cancer: a multicentre analysis

Prostate Cancer in Transplant Receivers—A Narrative Review on Oncological Outcomes

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