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Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort

SIMPLE SUMMARY: Currently, low-level and contrasting evidence exists to guide the management of prostate cancer diagnosed in renal transplant recipients. The authors aimed to assess whether PCa treatment and/or natural history differed when diagnosed in RTRs. Overall, they found that PCa did not see...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818510/
https://www.ncbi.nlm.nih.gov/pubmed/36612184
http://dx.doi.org/10.3390/cancers15010189
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author 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
author_facet 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
author_sort Marra, Giancarlo
collection PubMed
description SIMPLE SUMMARY: Currently, low-level and contrasting evidence exists to guide the management of prostate cancer diagnosed in renal transplant recipients. The authors aimed to assess whether PCa treatment and/or natural history differed when diagnosed in RTRs. Overall, they found that PCa did not seem aggressive and PCa outcomes were similar to available evidence in non-RTRs, although RTRs had a non-negligible risk of non-PCa-related death. The authors concluded that indiscriminate aggressive upfront PCa management in RTRs should be avoided. ABSTRACT: 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.
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spelling pubmed-98185102023-01-07 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 Cancers (Basel) Article SIMPLE SUMMARY: Currently, low-level and contrasting evidence exists to guide the management of prostate cancer diagnosed in renal transplant recipients. The authors aimed to assess whether PCa treatment and/or natural history differed when diagnosed in RTRs. Overall, they found that PCa did not seem aggressive and PCa outcomes were similar to available evidence in non-RTRs, although RTRs had a non-negligible risk of non-PCa-related death. The authors concluded that indiscriminate aggressive upfront PCa management in RTRs should be avoided. ABSTRACT: 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. MDPI 2022-12-28 /pmc/articles/PMC9818510/ /pubmed/36612184 http://dx.doi.org/10.3390/cancers15010189 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title_full Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title_fullStr Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title_full_unstemmed Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title_short Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
title_sort prostate cancer in renal transplant recipients: results from a large contemporary cohort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818510/
https://www.ncbi.nlm.nih.gov/pubmed/36612184
http://dx.doi.org/10.3390/cancers15010189
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