Immunosuppressive medication use associated with organ transplantation increase the risk of some cancers, and transplant candidates and recipients who have nonmetastatic prostate cancer (PCa) often receive treatment for the malignancy, even when low-risk PCa features would ordinarily justify use of active surveillance. New research published in the Journal of the National Cancer Institute, however, suggests that these patients do not need to be managed differently.
Of 163,676 PCa patients aged 66 years or older in the SEER-Medicare database, 320 men (0.4%) received a solid organ transplant up to 10 years before their cancer diagnosis and 300 men up to 5 years after their diagnosis. In analyses of a propensity score-matched cohort, the overall mortality rate at 10 years was significantly higher among transplant recipients than nonrecipients (55.7% vs 42.4%), but cancer-specific mortality rates at 10 years did not differ significantly between the groups (6.0% vs 7.6%), Stanley Liauw, MD, of the University of Chicago, and colleagues reported.
Among 334 transplanted men with T1-2N0, well/moderately differentiated low-risk PCa, cancer-specific mortality was similar for treated and untreated men.
“Overall, our findings suggest local therapy (radical prostatectomy or radiation therapy) or active surveillance may be justifiable in this population, as suited to individual patient risk factors and comorbidity, as per usual standards of care,” Dr Liauw’s team stated.
The study results also suggest that a waiting period for transplantation after treatment of low-risk PCa may not be justified.
Liauw SL, Ham SA, Das LC, et al. Prostate cancer outcomes following solid-organ transplantation: A SEER-Medicare Analysis [published online November 15, 2019]. J Natl Cancer Inst. doi: 10.1093/jnci/djz221