Prostate cancer active surveillance in solid organ transplant: a matched study and literature review

To evaluate outcomes of prostate cancer (PCa) active surveillance (AS) in patients with versus without solid organ transplant (SOT), as the safety of PCa AS in patients with SOT remains understudied. We also performed a literature review to identify all studies describing PCa AS in patients with SOT.

A retrospective study was conducted for patients with SOT (kidney, liver, heart, lung) with a diagnosis of PCa enrolled into AS either before or after SOT. Using prospectively collected information, they were matched with non-SOT AS patients at PCa diagnosis by age, race, prostate-specific antigen, and Gleason Grade Group (GGG). A scoping review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

A total of 32 SOT AS patients were matched with 99 non-SOT AS patients. After matching, there was no significant difference in baseline demographics. 34% were enrolled into AS before SOT. The median time on AS for patients with and without SOT was 4.7 and 4.98 years, respectively (P = 0.87). In all, 53% of patients with SOT and 54.5% those without SOT were still on AS (P = 0.99). In all, 28.1% of patients with and 39.4% without SOT progressed to definitive treatment (P = 0.30), and there were no differences in rates of grade re-classification or GGG at definitive treatment. No systemic disease progression or PCa-specific deaths occurred. In the literature, we identified and reviewed 11 studies and found 99 patients enrolled into AS either before (n = 33) or after (n = 66) SOT. We did not identify a safety signal.

We present the largest series of patients with PCa on AS with SOT. In patients with SOT and PCa on AS, a surveillance strategy appears safe and has similar outcomes as those without SOT on AS. Our review found a paucity of AS data in the SOT setting suggesting that further research is warranted.