Prostate cancer reduces the likelihood of kidney transplantation and increases the risk for death among men with end-stage kidney disease (ESKD) receiving dialysis, a new study finds.
Among 588,478 men aged 40-79 years on dialysis who were identified using 1999-2015 data in the US Renal Data System (USRDS), prostate cancer developed in 18,162 (3.1%). Investigators propensity score matched 15,554 patients with prostate cancer with 15,554 control patients without prostate cancer at the time of their counterparts’ diagnosis.
Survival rates were 76%, 48%, and 30% at 1, 3, and 5 years in the prostate cancer group, respectively, compared with 80%, 51%, and 33% in the control group. Men in the prostate cancer group had a significant 11% higher risk for death and 22% decreased likelihood of kidney transplantation compared with men in the control group, Nagaraju Sarabu, MD, MPH, of University Hospitals Cleveland Medical Center in Ohio, and colleagues reported in Kidney Medicine.
Kidney transplantation lowered the risk for premature death by a significant 80% in both patients with and without prostate cancer.
The 5-year relative survival of 91% for patients on dialysis with vs without prostate cancer is lower than a previously reported rate of 98% for the general population with vs without prostate cancer, the investigators noted. They discussed several possible contributors to the higher mortality rate: Advanced prostate cancer is more common among men with ESKD compared with the general population. Comorbidities characteristic of patients with ESKD may result in less aggressive prostate cancer treatment. Complications of prostate cancer treatments might be worse with ESKD. Finally, a delay in kidney transplantation due to prostate cancer may increase the chances of death. The USRDS database lacked details on individual prostate cancer cases, precluding analysis.
“Future studies should investigate the underpinnings of increased mortality and impact of delay in transplant in balancing risks of increased mortality associated with remaining on dialysis and benefits of avoiding progression of the cancer due to immunosuppression,” the investigators wrote.
Sarabu N, Schiltz N, Woodside KJ, et al. Prostate cancer, kidney transplant wait time, and mortality in maintenance dialysis patients: a cohort study using linked United States Renal Data System data. Published online September 28, 2021. Kidney Med. doi:10.1016/j.xkme.2021.07.008