Radical retropubic and perineal prostatectomy for clinically localised prostate cancer in renal transplant recipients

Abstract

ObjectiveTo analyse the functional and oncological outcome of consecutive renal-transplant recipients (RTRs) with clinically localised prostate cancer who underwent radical retropubic (RRP) or perineal (RPP) prostatectomy.Patients and methodsBetween January 2000 and July 2011 16 patients underwent RRP (group 1) and seven RPP (group 2). In all, 200 consecutive non-RTRs served as the control group, of whom 100 each underwent RRP and RPP, respectively. The mean (range) interval between renal transplantation and RP was 95 (24–206) months, the PSA at the time of diagnosis was 4.5 (3.0–17.5) ng/mL, and the mean patient age was 64 (59–67) years.ResultsThe mean follow-up was 39 (RRP) and 48 months (RPP). There was no deterioration in graft function. In group 1, 13 and three patients had pT2a-cpN0 and pT3a-bpN0 prostate cancer, respectively, with a Gleason score of 6, 7 and 8 in 11, three and one patients, respectively. In group 2, three and four patients had pT2a-c and pT3a-b disease, respectively, with a Gleason score of 6 and 7 in two and five, respectively. In both groups one patient had a positive surgical margin and was followed expectantly, and all patients have no evidence of disease. Wound infections developed more often in the RPP group (29% vs. 7%), but there were no Clavien grade III–V complications. All patients achieved good continence, and two need one pad/day.ConclusionsRRP and RPP are suitable surgical treatments for prostate cancer in RTRs. RRP might be preferable, as it has the advantage of simultaneous pelvic lymphadenectomy and a lower risk of infectious complications.

Prostate cancer treatment in renal transplant recipients: a systematic review

“…We included 27 studies reporting oncological and/or functional outcomes of PCa treatment in RTRs for a total of 241 patients from 25 cohort studies and nine case reports (Table ). Studies were published between 1991 and 2016 , including patients treated from 1968 .…”

“…The mean age of the RTRs ranged from 50 to 73 years, while the mean PSA level at PCa presentation ranged from 4.5 ng/mL to 143.9 ng/mL (Table ).…”

“…Criteria for preoperative staging were rarely stated (five studies). Complete staging using bone scan and pelvic CT or MRI was performed in high‐risk PCa only and in intermediate‐ and high‐risk PCa in two and one series, respectively. One study staged all patients, regardless of PCa risk .…”

“…In seven patients the LND side was not specified . Among patients undergoing bilateral LND, in three the standard technique was used , while the remaining 16 underwent only a limited dissection on the graft side . Criteria for node dissection were available in eight studies.…”

“…Data on functional outcomes and complications were available for six and 14 series, respectively, and for all the case reports (Table []). The mean operating time ranged from 92 to 322 min , blood loss (BL) ranged from 50 to 1 466 mL and hospital stay ranged from 1.8 to 11.9 days .…”