Prostate Cancer and Organ Transplantation Not Associated with Prostate Cancer-Specific Mortality

A study in the Journal of the National Cancer Institute suggested that among men age ≥66 with non-metastatic prostate cancer, an organ transplant is associated with higher overall mortality (OM) but no observable difference in prostate cancer-specific mortality (PCSM).¹

Based on the findings, researchers indicated that men with prostate cancer and previous or future organ transplantation should be managed per usual standards of care, including consideration of active surveillance for low-risk cancer characteristics. 

“We hope these results will spark discussion among oncologists and transplant physicians and challenge any policy that requires cancer therapy and a waiting period for all transplant patients with prostate cancer,” Stanley Liauw, MD, department of radiation and cellular oncology, University of Chicago, said in a press release.

In this SEER-Medicare cohort of 163,676 men aged ≥66 diagnosed with non-metastatic prostate cancer, 620 (0.4%) men were identified with transplant up to 10 years before or 5 years after prostate cancer diagnosis and matched with 3,100 men. At 10 years, OM was 55.7% and PCSM was 6.0% in the transplant cohort, compared to 42.4% (P < 0.001) and 7.6% (P = .70) in the non-transplant cohort. 

Adjusted models showed no difference in PCSM for transplanted men (HR, 0.88,; 95% CI, 0.61-1.27; P = .70) or differences by prostate cancer therapy. Among 334 transplanted men with T1-2N0, well/moderately differentiated “low-risk” prostate cancer, PCSM was similar for treated and untreated men (HR, 0.92; 95% CI, 0.47-1.81). 

“Overall, our findings suggest local therapy (radical prostatectomy or radiation therapy) or active surveillance may be justifiable in this population, as suited to individual patient risk factors and comorbidity, as per usual standards of care,” the researchers wrote. 

Among the transplanted men, 37 (6.0%) died of prostate cancer, 308 (49.7%) died of other causes, and 345 (55.6%) died overall. Transplanted patients were younger, more likely to be non-white, live in the West vs the Midwest and South, and have multiple comorbidities and shorter follow-up after prostate cancer diagnosis. 

Guidelines from the European Association of Urology on renal transplantation in 2005 deemed any active neoplasia a contradiction for transplantation; however, a guideline update released in 2018 recognized that a waiting period after treatment of a low-risk prostate cancer may not be warranted.

In a survey of 90 American transplant surgeons published in Urologic Oncology, 89% routinely performed PSA screening prior to renal transplant, 45% required treatment of a newly diagnosed prostate cancer prior to transplant, and 73% indicated a variable waiting time following treatment dependent on the stage and risk of cancer.

The International Society for Heart and Lung Transplantation proposed that transplant after a cancer diagnosis would ideally occur in collaboration with oncology specialists, at a time when the risk of cancer recurrence is perceived to be low and not necessarily at an absolute time point. 

“There are no widely accepted guidelines regarding prostate cancer screening or treatment in the transplant population,” Liauw said. 

Immunosuppressive drugs, whether acquired or iatrogenic, are associated with an increased risk of developing solid tumors. The 4 most common cancers among transplant recipients according to the National Cancer Institute are non-Hodgkin lymphoma and cancers of the lung, kidney, and liver.²

References:

1. Liauw SL, Ham SA, Das LC, et al. Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis. JNCI. doi:10.1093/jnci/djz221.

2. National Cancer Institute. Immunosuppression. National Cancer Institute website. Published April 29, 2015. cancer.gov/about-cancer/causes-prevention/risk/immunosuppression. Accessed December 11, 2019.