Impact Of PSA And Prostate Cancer On Solid Organ Transplantation - Annual Meeting Of The American Urological Association

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 21 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Waleed Al-Khudair led this panel discussion. Should a patient with CaP be able to donate his kidney to a family member? When should a patient treated for CaP become eligible for a renal transplant? These questions were presented to the panel.

Dr. Catalona stated that patients on hemodialysis have the same or slightly higher risk for CaP. The transplant candidate guidelines are similar to those for all men. They historically stated that men should wait 2 years after treatment to get a transplant. 60% of transplant physicians would not transplant if CaP is discovered and 95% believe that immunosuppression increases risk of CaP progression. Overall, 12% of cadaveric donors harbor CaP at autopsy; this is higher in men >age70 and in African-American men. Regarding PSA levels in patients on hemodialysis, free PSA is cleared by the kidney as well as low-flux dialysis membranes. Total PSA levels are unchanged, but free PSA levels and %-free PSA levels are higher prior to dialysis and decrease after dialysis. The treatment options for ESRD patients should be the same as or men without renal failure. The CaP specific mortality is the same, but death due to comorbidities is higher. The risk of dying during 5 years of dialysis is 59%. Due to risk of femoral head avascular necrosis, radiotherapy should exclude this anatomic area.

Dr. Barry succinctly addressed when patients with ESRD and CaP can be treated. After renal transplantation, patients have a 0.7x-fold life expectancy compared to normal men. Residual CaP that responds to treatment in men who have a 0.7x life expectancy should be considered for transplantation. Nomograms should determine life expectancy and treatment. If a deceased donor has autopsy CaP, the organs should not be transplanted. If a living donor is successfully treated for CaP he should still not be a donor, he concluded.

Moderated by: Waleed Al-Khudair, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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