Diagnosis and treatment of prostate cancer in renal-transplant recipients

The incidence and treatment of prostate cancer in male renal-transplant patients has not been extensively evaluated. With the aging of the renal-transplant population, the diagnosis and management of prostate cancer in these patients needs further evaluation. In this study, we conducted a retrospective review of data from 498 male renal-transplant patients to evaluate the prevalence, treatment, and outcome of prostate cancer in this population. Of the 498 male renal-transplant patients, nine were diagnosed with prostate cancer. A prostate specific antigen (PSA) screening program was not utilized, and these patients were diagnosed based on a prostate digital rectal examination and/or elevated PSA. The median age at transplantation was 55 years, and the median age at the diagnosis of prostate cancer was 63.6 years. One patient was treated with androgen ablation alone, four patients were with radiation alone, and four patients were treated with a combination of androgen ablation and external radiation. Twelve skin malignancies occurred in five of the patients with prostate cancer. Our patient population was preferentially treated with radiation therapy rather than radical prostatectomy. Seven of these treated patients are currently being followed and have good control of the disease. Two of the seven patients are on dialysis because of chronic allograft nephropathy. One patient was lost to follow-up, and one died with extensive metastasis, paraplegia, and renal failure. The incidence of diagnosed prostate cancer in patients with renal transplant will increase because of systematic PSA screening. The recommended current treatment modality depends on the Gleason grade, stage, PSA levels, and associated comorbid conditions. A combination of radiation treatment with androgen ablation provides good control of the disease while preserving renal function.