Immunosuppressive medications – drugs given to organ transplant recipients so their bodies won't reject the donor organ - could weaken the immune system's ability to find and destroy cancer or fight infections that contribute to cancer. As a general rule, candidates for solid organ transplant who are newly diagnosed with any type of cancer must be treated - and be without a recurrence for a period of time -;in order to become eligible for transplant. Post-transplant patients with a cancer diagnosis may also potentially require more aggressive treatment and surveillance.
In a paper published in the Journal of the National Cancer Institute, a group of radiation oncologists, urologic oncologists and transplant specialists, evaluated whether transplant history alters the outcomes of men who are diagnosed with prostate cancer as a result of the PSA screening test.
There are no widely accepted guidelines regarding prostate cancer screening or treatment in the transplant population."
Stanley Liauw, MD, radiation oncologist, author on the paper
Examining cancer statistics available in the SEER-Medicare database, the group explored the association between solid organ transplant and prostate cancer over a 20-year time period, including a matched cohort of 620 men with prostate cancer and transplant, and 3,100 men with prostate cancer without a transplant. Mortality rates from prostate cancer in men over 66-years-old did not vary significantly between those who did, and those who did not, have an organ transplant. In addition, patients who underwent transplant and had untreated "low-risk" prostate cancer did not have higher rates of death than those who had treatment.
These findings suggest men with prostate cancer and previous or future organ transplantation may be managed with the usual standards of care, including consideration of active surveillance for low-risk disease, the study authors concluded.
"We hope these results will spark discussion among oncologists and transplant physicians, and challenge any policy that requires cancer therapy and a waiting period for all transplant patients with prostate cancer, " Liauw said.
Liauw, S.L., et al. (2019) Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis. JNCI: Journal of the National Cancer Institute. doi.org/10.1093/jnci/djz221.