Radical Retropubic Prostatectomy For Localized Prostate Cancer In Renal Transplant Patients

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer;  Transplants / Organ Donations
Article Date: 02 Jul 2008 - 1:00 PDT

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UroToday.com - In the online issue of Urology, Dr. Antonopoulos and colleagues from Brazil present an approach for surgical treatment of localized prostate cancer (CaP) in men who have already undergone renal transplantation.

The protocol was established between August 2004 and November 2007. During that time period 8 men who had undergone renal transplantation were diagnosed with CaP. The cutoff for PSA used to biopsy was 2.5ng/ml; all men underwent 12-core TRUS/biopsy and had a metastatic workup. All these men had retroperitoneal transplantation previously to the iliac vessels with a non-stented Gregoir ureteral reimplantation. They were all on triple drug immunosuppression. All 8 patients had a retropubic prostatectomy (RP) and 7 had pelvic lymphadenectomy, but only on the side opposite the renal transplant. Immunosuppressive medicines were resumed at the same time that diet was advanced. All were discharged to home on the 5th postoperative day.

No major complications occurred. The mean age of these men was 59.6 years and the mean interval between renal transplant and RP was 90 months. Mean operative duration was 183 minutes, mean EBL was 656cc and two obese patients required blood transfusion. The prior renal transplant did not impair the operation or ability to bring the bladder down into the pelvis for the urethral anastomosis. They only modified the ipsilaterial pelvic lymphadenectomy on the renal transplant side. No patient experienced any loss or renal allograft function and with a mean follow-up of 11.9 months, all PSA levels remained undetectable. Six of 8 men achieved full continence.

In summary, RP after renal transplantation is feasible, but only a unilateral pelvic lymphadenectomy on the side opposite the renal allograft is recommended.

Antonopoulos IM, Nahas WC, Piovesan AC, Falci R Jr, Kanashiro H, Alvarez GA, Srougi M
Urology. 2008 May 14. [Epub ahead of print]
doi:10.1016/j.urology.2008.03.041

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

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