Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
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Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort. / Marra, Giancarlo; Soria, Francesco; Peretti, Federica; Oderda, Marco; Dariane, Charles; Timsit, Marc-Olivier; Branchereau, Julien; Hedli, Oussama; Mesnard, Benoit; Tilki, Derya; Olsburgh, Jonathon; Kulkarni, Meghana; Kasivisvanathan, Veeru; Lebacle, Cedric; Rodriguez-Faba, Oscar; Breda, Alberto; Soeterik, Timo; Gandaglia, Giorgio; Todeschini, Paola; Biancone, Luigi; Gontero, Paolo; On Behalf Of The Collaborators.
In: CANCERS, Vol. 15, No. 1, 189, 28.12.2022.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
AU - Marra, Giancarlo
AU - Soria, Francesco
AU - Peretti, Federica
AU - Oderda, Marco
AU - Dariane, Charles
AU - Timsit, Marc-Olivier
AU - Branchereau, Julien
AU - Hedli, Oussama
AU - Mesnard, Benoit
AU - Tilki, Derya
AU - Olsburgh, Jonathon
AU - Kulkarni, Meghana
AU - Kasivisvanathan, Veeru
AU - Lebacle, Cedric
AU - Rodriguez-Faba, Oscar
AU - Breda, Alberto
AU - Soeterik, Timo
AU - Gandaglia, Giorgio
AU - Todeschini, Paola
AU - Biancone, Luigi
AU - Gontero, Paolo
AU - On Behalf Of The Collaborators, null
PY - 2022/12/28
Y1 - 2022/12/28
N2 - Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60−73) and 45.9 mL/min (IQR 31.5−63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48−191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02−10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31−106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16−0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
AB - Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60−73) and 45.9 mL/min (IQR 31.5−63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48−191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02−10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31−106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16−0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
U2 - 10.3390/cancers15010189
DO - 10.3390/cancers15010189
M3 - SCORING: Journal article
C2 - 36612184
VL - 15
JO - CANCERS
JF - CANCERS
SN - 2072-6694
IS - 1
M1 - 189
ER -