Importance of tumoral markers in donors: study of prostate-specific antigen

We established a protocol to determine the serum prostate-specific antigen (PSA) in male donors of 50 years or older, and to histologically examine the prostate glands. From January 1997 to December 2002 we analysed serum PSA in 51 cases, of which it was normal in 34 and high in 17. Prostate glands were examined histologically in 13 of the high PSA cases. Donors were classified according to the PSA level and histology: donors with high PSA values and adenocarcinoma or high-grade PIN (group A, n=6); donors with elevated PSA but no malignancy (group B, n=7); and donors with normal PSA (group C, n=34). The ages, days in hospital, and causes of death were similar among the 3 groups. The levels of PSA were significantly higher among group A than group B or group C, but were similar between group B and C. The list of transplanted organs is as follows: 5 organs of group A; 8 organs of group B; and 59 organs of group C.

High PSA levels seem show 2 patterns: (1) small increases of PSA related to donors with no prostate cancer, and (2) high levels of PSA related to the presence of prostate cancer, as is the case in the general population. The incidence of prostate cancer in overall male donors was 3.1%. Due to this high incidence, we believe it is important to determine PSA levels to diagnose prostate cancer in older donors. A separate consideration is what to do with the organs of those donors.