Aggressive Prostate Cancer at Presentation Following Solid Organ Transplantation

Area of Science:

• Urology
• Oncology
• Transplant Medicine

Background:

• Solid organ transplant (SOT) candidates and recipients often undergo rigorous screening, potentially causing harm and delaying transplants.
• Previous studies suggested an elevated prostate cancer (PCa) risk in SOT recipients, but contemporary data indicate similar outcomes for low- or intermediate-risk PCa.
• Limited data exist on the association between prior transplant history and aggressive PCa risk at presentation.

Purpose of the Study:

• To investigate the relationship between solid organ transplant (SOT) exposure and the risk of developing aggressive prostate cancer (PCa).
• To determine if SOT recipients require more intensive screening protocols for PCa compared to the general population.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of SOT patients who developed PCa after PSA screening.
• Employed procedure and diagnosis codes to identify patients with a history of SOT.
• Defined aggressive PCa phenotype by mortality from PCa, de novo metastasis, regional lymph node metastasis, PSA >20 ng/L, or Gleason score 8-10.

Main Results:

• Analysis of 292 transplant patients revealed no significantly higher risk of aggressive prostate cancer phenotype on univariable and multivariable analyses.
• Odds ratios for aggressive PCa in transplant patients were 0.95 (95% CI 0.72-1.25) and 1.18 (95% CI 0.90-1.57), respectively.
• Transplant history was not associated with an increased risk of aggressive PCa.

Conclusions:

• Solid organ transplant recipients do not appear to have an elevated risk of aggressive prostate cancer.
• Current evidence suggests that transplant recipients can follow similar prostate cancer screening protocols as the general population.
• More rigorous screening protocols are unlikely to benefit transplant recipients.