Introduction

Renal transplant recipients (RTR) are usually considered at higher risk of malignancy. In recent years, prostate cancer in RTR has been becoming more frequent, probably due to the higher age and the longer survival of RTR.

Despite this growing interest, few data are available in the literature. We report our experience in therapeutic management and outcome after prostate cancer diagnosis during a 20 year follow up period.

Methods

We retrospectively reviewed the data from 521 male RTR who underwent renal transplantation at our department during July 1991–December 2011 period. Mean follow up post transplant was 2237±1732 days with a medium age of 48.79 ±12.21years. Our screening program for prostate cancer is based on annual prostate specific antigen (PSA) evaluation and prostate digital rectal examination. Diagnosis is made by random trans rectal ultrasound guide biopsy.

Results

Prostate cancer was detected in eleven patients (2.7%). The median age at transplantation was 50 years (range, 42-67 years), the median dialytic time was 49.8 months (range, 12-204 months) and the median age when prostate cancer was diagnosed was 57 years (range, 42-67 years). The median time between transplantation and cancer diagnosis was 88.52 months (range, 12-227 months).The immunosuppressive regimen was based on double or triple drug association with steroid, cyclosporine and mycofenolate mofetil.

Nine patients underwent retro pubic radical prostatectomy, one of these was submitted to adjuvant radiotherapy; only two patients were treated with a combination of androgen ablation and external radiotherapy. Eight patients are currently followed with a good control of the disease and good renal function. Two patients died for cardiovascular complications. One patient died with extensive metastasis due to prostate cancer.

Conclusion

We recommend systematic PSA screening in the follow up of RTR. Surgical treatment is a feasible option. The immunodeficiency status of these patients plays a crucial role in the outcome of RTR and a multimodal approach represents the gold standard for long term survival results.

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