Lung Transplantation in Men With High-Risk Prostate Cancer

Transplantation in patients with active malignancies is controversial due to concerns about immunosuppression accelerating cancer progression and ethical allocation of donor organs. Prostate adenocarcinoma has a non-immunogenic profile and can respond to temporizing non-chemotherapeutic treatments such as androgen deprivation therapy (ADT). We examine two cases of lung transplantation (LT) in patients with high-risk prostate cancer (PCa) diagnosed during pretransplant evaluation, in whom transplantation was prioritized before definitive cancer treatment.

Single-center retrospective review of patients with end-stage organ dysfunction who underwent solid organ transplant between January 2018 and October 2023 after being diagnosed with high-risk PCa and before definitive oncologic treatment.

Two patients met inclusion criteria. One had end-stage interstitial lung disease and the other had post-COVID-19 pulmonary fibrosis; both had WHO group III pulmonary hypertension and underwent expedited LT after being diagnosed with high-risk PCa on pretransplant malignancy screening. One patient was treated with ADT pre-transplant and definitive external beam radiotherapy post-transplant. The second patient has not received definitive therapy for his PCa. Both remain alive with ongoing management of their clinically localized cancer at 24 and 10 months post-transplant, respectively.

In experienced transplant centers, it is reasonable to prioritize lifesaving transplantation for patients with newly diagnosed, localized high-risk PCa. The favorable prognostic characteristics and treatment options for PCa make it possible to balance the mortality benefit of transplantation with the risks of temporarily deferring cancer treatment even in the setting of high-risk disease. Expanding the recipient pool to include this population should be considered.