Current recommendations for delaying renal transplantation after localized prostate cancer treatment: are they still appropriate?
Overview
abstract
BACKGROUND: Since the advent of prostate-specific antigen (PSA) testing, most men diagnosed with prostate cancer (PC) have localized disease, which is curable with surgery or radiation therapy. Current policy for patients with end-stage renal disease (ESRD) and PC recommends waiting 5 years after primary therapy before enrollment on the transplant waiting list. The risk of dying during 5 years of dialysis is approximately 59%, whereas the risk of PC recurrence after surgery is generally much lower. Prognostic tools called nomograms can accurately assess a patient's probability of PC recurrence. This prompted the authors to reexamine current transplantation policy for patients with PC. METHODS: The authors reviewed the Sloan-Kettering PC database to identify patients on dialysis undergoing radical prostatectomy. Clinical and pathologic features were analyzed to determine the likelihood of disease recurrence. RESULTS: The authors identified two patients with ESRD in their PC database. Both men had elevated serum PSA detected during routine pretransplantation evaluation, and biopsy confirmed the PC. Both opted for surgery, with pathologic analysis revealing organ-confined disease and negative surgical margins. The postoperative nomogram predicted 7-year progression-free probabilities of 95% and 98%. Given the high likelihood of cure of their PC, immediate consideration for renal transplantation seemed appropriate for both patients. CONCLUSIONS: PSA-based screening of the dialysis population has ensured earlier detection of PC. Given that nomograms will accurately predict the risk of PC recurrence, the time a patient must wait for a transplant should be based on this individualized risk assessment rather than on a general rule.
