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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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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. |
format | Online Article Text |
id | pubmed-9818510 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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