Current recommendations for delaying renal transplantation after localized prostate cancer treatment: Are they still appropriate? Journal Article

  

Authors:	Secin, F. P.; Carver, B.; Kattan, M. W.; Eastham, J. A.
Article Title:	Current recommendations for delaying renal transplantation after localized prostate cancer treatment: Are they still appropriate?
Abstract:	Background. Since the advent of prostate-specific antigen (PSA) testing, most men diagnosed with prostate cancer (PC) have localized disease, which is curable with surgery or radiation therapy. Current policy for patients with end-stage renal disease (ESRD) and PC recommends waiting 5 years after primary therapy before enrollment on the transplant waiting list. The risk of dying during 5 years of dialysis is approximately 59%, whereas the risk of PC recurrence after surgery is generally much lower. Prognostic tools called nomograms can accurately assess a patient's probability of PC recurrence. This prompted the authors to reexamine current transplantation policy for patients with PC. Methods. The authors reviewed the Sloan-Kettering PC database to identify patients on dialysis undergoing radical prostatectomy. Clinical and pathologic features were analyzed to determine the likelihood of disease recurrence. Results. The authors identified two patients with ESRD in their PC database. Both men had elevated serum PSA detected during routine pretransplantation evaluation, and biopsy confirmed the PC. Both opted for surgery, with pathologic analysis revealing organ-confined disease and negative surgical margins. The postoperative nomogram predicted 7-year progression-free probabilities of 95% and 98%. Given the high likelihood of cure of their PC, immediate consideration for renal transplantation seemed appropriate for both patients. Conclusions. PSA-based screening of the dialysis population has ensured earlier detection of PC. Given that nomograms will accurately predict the risk of PC recurrence, the time a patient must wait for a transplant should be based on this individualized risk assessment rather than on a general rule.
Keywords:	adult; treatment outcome; aged; middle aged; surgical technique; review; anamnesis; case report; postoperative period; preoperative evaluation; diagnostic procedure; data base; cancer therapy; prostate cancer; prostate-specific antigen; prostatic neoplasms; prostatectomy; recurrent disease; radical prostatectomy; kidney biopsy; nomogram; kidney transplantation; kidney failure, chronic; dialysis; end-stage renal disease; humans; human; male; priority journal; progression-free probability
Journal Title:	Transplantation
Volume:	78
Issue:	5
ISSN:	0041-1337
Publisher:	Lippincott Williams & Wilkins
Date Published:	2004-09-15
Start Page:	710
End Page:	712
Language:	English
DOI:	10.1097/01.tp.0000130176.82960.fd
PROVIDER:	scopus
PUBMED:	15371673
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-4544367537&partnerID=40&md5=dde92b06ae26f48e9a0a7ba04885578c
Notes:	Transplantation -- Cited By (since 1996):10 -- Export Date: 16 June 2014 -- CODEN: TRPLA -- Source: Scopus

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