Transplanting a Kidney and having Low-Risk Prostate Cancer in Men

Mansoor Ali^* and Zaheed Ahmed
^*Correspondence: Mansoor Ali, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA, Email:

Keywords

Kidney transplant • Renal failure • Dialysis

Introduction

The average age of patients who have been listed for and treated with a kidney transplant (KT) for end-stage renal disease renal failure has become more prevalent. France's ratio is grown from 2.5% to 6% of patients over 65 years old on the waiting list. Using PubMed, a thorough literature search was carried out to find and evaluate original publications explaining patient life expectancy (LE) while receiving RRT. Similar to this scholarly works that detail either untreated or treated natural historytypes of low-risk PCa were chosen. Any form of cancer that is associated with a high chance (>75%) of survival past 10 years was classified as falling under the low-risk PCa group. A consensus among all writers was reached when reviewing and choosing articles that were published between 1991 and 2018. Immunosuppression, which is necessary for organ transplantation and was previously thought to be a risk factor for tumour induction and tumour progression in all forms of malignancy, is required. Therefore, organ transplantation was formerly thought to be contraindicated in any case of active neoplasia. However, mounting research suggests that the elevated risk of tumours by immunosuppression, which only affects some subgroups of malignancy while having no effect on others, including prostate cancer (PCa).

Description

A large percentage of elderly men undergoing KT must,be expected to have PCa that is subclinical. These men would be at a high risk of developing symptomatic PCa if immunosuppression promoted PCa progression. Despite the fact that transplant recipients are getting older, there hasn't been any evidence of an increase in PCa incidence, morbidity, or mortality when compared to the general population, indicating that KT and immunosuppression have no impact on PCa's normal course.

Using PubMed, a thorough search of the literature was carried out to find unique articles and evaluate posts explainingPatient life expectancy (LE) after RRT [1]. Along the same lines,articles documenting natural history that has either been treated or notwere chosen from low-risk PCa groups. Any type of disease that is linked to a high likelihood (>75%) of survival past 10 years is considered to fall into the low-risk PCa group. All of the authors evaluated and agreed upon the selection of articles that were published between 1991 and 2018.

The best current research suggests that it is sufficient to tell patients who are worried that KT and immunosuppression are unlikely to enhance PCarelated risks. Therefore, it is desirable to base the decision to list or not list on an acceptable balance between the LE following transplantation and the potential life-limiting effect of PCa under various circumstances or treatment approaches [2].

89% of programmes conducted a regular prostate-specific antigen (PSA) screening programme, and 71% had PCa screening recommendations in place. 50 years old was the average age to begin screening, and 79% of the programmes had no set maximum age. Before moving forward with transplantation, 45% of the responding hospitals believed that definitive PCa treatment was necessary. But 67% of the respondents said active surveillance was a good idea.

The finest studies of the natural course of disease in low-risk PCa compare active curative treatment with no curative treatment (watchful waiting, WW), like SPCG-4. After 18 years of follow-up, PCa-related deaths had been noted in 20/131 patients who were receiving WW (14.0%) and in 11/118 patients who had undergone prostate surgery (10.2%). Given the dramatic decline in quality of life that occurs years before tumor-related death [3], the presence of metastases must be considered the more trustworthy endpoint for clinical interpretation of such research. After prostatectomy and WW, the metastatic rates were 15/118 (13.6%) and 35/131 (24.2%), respectively (p = 0.006).

The series was created at a period when the clinical importance and available BR treatments were not fully understood. Palliative androgen deprivation therapy (ADT) had previously only been advised in cases of apparent distant or symptomatic metastases. Despite therapeutic strategies that, from a practical standpoint, must be considered outmoded, median survival had not been attained after 16 years of observation [4].

The statistics show, on the one hand, that many individuals with lowrisk PCA do not benefit from curative treatment. In this experiment, this was especially true for older patients over the age of 65. However, after 18 years of follow-up, curative treatment greatly decreased the probability of metastasis. Further LE and competing mortality emerge as significant covariables that must be taken into account when interpreting these data: in the WW-arm of SPCT-4, 65/131 low-risk patients had died without developing PCa, indicating a relatively high risk of PCa metastases in the 66 remaining patients with a proven LE of more than 18 years.

Even if KT patients must be considered to have LE that is not much longer than 15 years, their risk of developing an untreated low-risk PCa may still be minimal: These patients are anticipated to live significantly fewer years when they are not included in the transplant programme than they would have otherwise due to their untreated tumour [5]. Low-risk PCa cannot be viewed as strictly contraindicative to a KT based on pure lifetime estimates, even when it is kept untreated.

According to a recent study, individuals who had prostatectomy and had unfavorable pathology (Gleason score 8, pT3b, pT4, pN+, and/or Gleason 7 with positive margins) had their clinical outcomes examined. Patients had received adjuvant ADT Mitoxantron treatment for two years. Ten-year overall survival rates in both arms were 86–87%, much better than the protocol's original expectation of 50% [6]. Multimodal postoperative treatment can therefore prolong the LE to an amount that may allow qualification for KT listing, even in individuals whose condition cannot be treated by surgery alone.

Conclusion

We are unaware of any conclusive evidence that immunosuppression and KT increase the risk of PCa, either in terms of incidence or aggressiveness. Therefore, in patients receiving KT or in candidates for KT, PCa screening and treatment should be done individually based on lifetime risk assessments. Particularly, it is not possible to consider low-risk PCa symptoms that are ignored or perhaps incurable as a strong contraindication to KT. The findings likely apply to organ transplantation in general and are not specific to KT. When years of life aren't taken into account, the lack of an organ replacement therapy comparable to dialysis is extremely detrimental to patients awaiting liver or lung transplants.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

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