Urothelial carcinoma after kidney transplant: a heterogeneus entity in terms of diagnosis, treatments and oncological outcomes: mp06‐17

INTRODUCTION AND OBJECTIVES: Prostate cancer (PC) in renal transplant recipients (RTR) has not been widely studied and its incidence remains controversial, reported 2-5 times more than general population. The management of this disease is challenging because it is believed that RTR under immunosuppressive therapy may have increased postoperative morbidity and higher rate of tumor progression. Currently there are not guidelines or consensus about the management of this condition. The aim of the study was to analyze our experience in the management of PC in RTR. METHODS: Prospective and consecutive study in a single tertiary centre from 2003-2015. Inclusion of RTR diagnosed of PC by urinary symptoms, prostatic specific antigen (PSA), digital rectal examination, imaging and biopsies. PC assessment for staging and treatment was in agreement with the contemporary guidelines for the general population. Main outcome measures included demographics, characteristics and associated factors, type of treatment, complications, oncological outcomes and follow-up. Retrospective and descriptive analysis. RESULTS: During the study period 1330 renal transplants were performed, diagnosed of PC in 28 RTR (2.1%), mean age 66 years 6.6 (51-78). Type of donors were cadaveric (n1⁄426) and live (n1⁄42). Immunosuppressive therapy: without mTOR (n1⁄414) and with mTOR (n1⁄414). Mean time between renal transplantation and PC diagnosis 111 months 75 (24-270). Median PSA of 9.6ng/ml and PSA ratio 0.19. Treatment: a) Radical prostatectomy (n1⁄420): perineal approach (n1⁄416), laparoscopic (n1⁄42), robotics (n1⁄42)/ lymphadenectomy was performed in one patient; b) Radiotherapy combined with hormone therapy (n1⁄46); c) Active surveillance (n1⁄42). Histology: pT2 (n1⁄415), pT3a (n1⁄44) and pT3b (n1⁄41). No graft loss due to PC treatment was reported. Complications (18%): incontinence post-prostatectomy (n1⁄42), anastomotic stricture (n1⁄42) and urinary fistula (n1⁄41). Outcomes: Remission of the 85% (n1⁄422), Biochemical recurrence after radical prostatectomy treated with salvage radiotherapy (n1⁄44). Mortality by other causes without evidence of recurrence (n1⁄411), loss of monitoring (n1⁄41). Not specific mortality from cancer prostate was reported. Observed survival rates were 100% at 12 months after treatment. Mean follow-up was 61 months 37 (12-132). CONCLUSIONS: This is the first largest series to analyze the management of PC in RTR from a single center in Spain. PC after renal transplantation could be managed as any non-organ transplant patient with the same range of therapeutic options. According to our experience, these patients has similar histopathologic evaluation, posttreatment complications, rate of remission and recurrence than non-transplant patients, without specific mortality from PC. Active surveillance should also be provided in RTR despite being under immunosuppressive treatment.