Prostate cancer treatment in renal transplant recipients: a systematic review

Abstract

The aim of this review was to summarize the current evidence and to highlight the main issues future research needs to address regarding prostate cancer (PCa) treatment in renal transpant recipients (RTRs). We conducted a search of AMED, Medline and Embase up to 17 November 2016 to investigate oncological and functional outcomes of PCa treatment in RTR. Type and use/protocols of immunosuppression and peri-operative antibiotic drugs were also assessed. The search was implemented manually. Exclusion criteria were absence of full text or absence of information that allowed us to differentiate oncological and/or functional outcomes of each therapeutic approach used. We included 241 patients from 27 retrospective studies published between 1991 and 2016; seven of the studies were case-control and 20 were case series. We also considered nine case reports published between 1999 and 2016. Follow-up ranged from 1 to 120 months. PCa was organ-confined, with Gleason score ≤6 in 75.2% and 60.4% of patients. Surgery was the most frequent treatment used (n = 186), for which cancer-specific (CSS) and overall survival (OS) rates were both 96.8%. Functional outcomes, including continence and erectile function, and complications were less frequently reported and were generally similar to those reported for radical prostatectomy (RP) in non-RTRs. Other treatment methods in the patients included in the review were radiotherapy (RT) ± androgen deprivation therapy (ADT; n = 34; OS 88.2%; CSS 88.2%), ADT alone (n = 14; OS 42.9%; CSS 64.3%), brachytherapy (BT; n = 11; OS and CSS 100%), watchful waiting (n = 4) and active surveillance (n = 1). Overall no treatment-related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Outcomes of PCa treatment in RTRs are encouraging and do not appear to be inferior to those of non-RTR. RP was the most commonly assessed approach, whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High-quality studies are needed because the current level of evidence is low, and our results should therefore be interpreted with caution.

Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches

“…One (11.1%) Clavien-Dindo grade II complication was described due to a systemic inflammatory syndrome for urinary tract infection. The hospital stay consisted in 4 (3-6) days, while the days of catheterization were 7 (6-8) days.…”

“…To date, few data have been reported regarding active surveillance (AS) or watchful waiting (WW) for PCa in KTRs (8). However, non-active treatments would be perhaps adopted in the future even in this specific low risk PCa population.…”

Management of Active Surveillance-Eligible Prostate Cancer during Pretransplantation Workup of Patients with Kidney Failure: A Simulation Study

“…The implementation of an active surveillance approach in this population is currently hampered by two concerns: The first one relates to the belief that a post-transplant status might negatively interfere with definitive treatment. However, this fear is not supported by a recently published systematic review (18) showing that these patients can be managed with the same range of therapeutic options as the general population (19)(20)(21)(22). The second concern involves the effect of immunosuppression on cancer progression.…”

Radiotherapy of prostate cancer in renal transplant recipients: single-center experience

“…A recent review of treatment approaches in renal transplant recipients with diagnosed PCa reports that the most frequent treatment is surgery (n=186), with overall survival rates of 96.8% [7]. Further, only 20 renal transplant recipients with PCa undergoing brachytherapy treatment have been reported in the literature (Table 2); and all as solo therapy [8][9][10][11][12].…”