Prostate Specific Antigen-Positive Deceased Organ Donor: A Pathologist Is Indispensable

Area of Science:

• Organ transplantation
• Urology
• Pathology

Background:

• Demographic changes and lack of clear algorithms for prostate specific antigen (PSA)-positive donors may decrease organ recovery.
• Tumor marker testing in potential donors is now recommended in Poland.
• Elevated PSA levels (high PSA >10 ng/mL) led to disqualification of 10% of deceased donors in the first year of this recommendation.

Purpose of the Study:

• To evaluate the utility of histopathological examination of the prostate in deceased organ donors.
• To determine the correlation between PSA levels and prostate cancer (CaP) or high-grade prostate intraepithelial neoplasia (HGPIN) in donors.
• To assess the impact of prostate evaluation on the organ donor pool.

Main Methods:

• A total of 52 male deceased organ donors (median age, 54 years) were included from January 2010 to January 2014.
• All donors underwent routine histological evaluation of the entire prostate, irrespective of PSA levels.
• Prostate specific antigen (PSA) levels were recorded and analyzed in relation to histopathological findings.

Main Results:

• Carcinoma of the prostate (CaP) was detected in 6 donors (12%).
• No significant correlation was found between PSA levels and the presence of CaP (median 7.0 vs 3.9 ng/mL; P=.51) or HGPIN (median 5.9 vs 4.3 ng/mL; P=.14).
• All organs (12 kidneys, 3 livers) from donors with CaP were successfully transplanted, increasing the organ donor pool by 15%.

Conclusions:

• Prostate specific antigen (PSA) values are not associated with the occurrence of prostate cancer in deceased organ donors.
• Histological verification of the prostate in donors allows for an increased organ pool without compromising safety standards.