Radical retropubic prostatectomy in immunosuppressed transplant recipients

Purpose: Surgical treatment of transplant recipients in whom prostate cancer subsequently develops has been reported only sporadically in the literature. We reviewed our experience with radical retropubic prostatectomy in patients with solid organ transplants. Materials and Methods: Using our prostatectomy registry we identified 17 patients who underwent radical retropubic prostatectomy between 1988 and 2005 following organ transplantation. Clinicopathological features and outcome data were reviewed. Results: Kidney, liver and heart transplants were performed before radical retropubic prostatectomy in 9, 7 and 3 patients, respectively. Median age at transplant and time of radical retropubic prostatectomy was 51 (range 37 to 65) and 59 years (range 45 to 70), respectively. Median prostate specific antigen was 5.8 (range 2.6 to 12.9) and all patients had clinically localized disease. Ten patients had a pathological Gleason score of 6 while the remaining had Gleason scores 7 or greater. No patient had positive lymph nodes and only 2 patients had pT3a or greater disease. Early complications included wound infection in 2 (12%) patients along with hematoma and myocardial infarction in 1 (6%) patient each. Late complications included incontinence (I or more pads per day) in 2 patients while no patient had a hernia, bladder neck contracture, venous thrombosis or lymphocele. With a median followup of 4.9 years, biochemical recurrence developed in 1 patient and no patient had systemic progression or death due to prostate cancer. Conclusions: To our knowledge we report the largest experience with radical retropubic prostatectomy in transplant recipients. Our results suggest that radical retropubic prostatectomy is feasible for immunosuppressed patients, yet concern for infection and wound healing remain important. Healthy transplant recipients with an increased prostate specific antigen should undergo a prostate biopsy.