Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review.

BACKGROUND: The majority of kidney transplants are performed in recipients (RTR) over 50; simultaneously their life expectancy is improving. The increasing age and number of RTR is likely to be paralleled by an increase of prostate cancer (PCa) incidence. However, little is known on the optimal management of these patients who represent a therapeutic challenge due to medical and anatomical graft-related issues. METHODS: AMED, Medline and Embase were searched until November 17(th) , 2016 adhering to the PRISMA guidelines and the AMSTAR checklist to investigate oncological and functional outcomes of PCa treatment in RTR. Type of immunosuppression and peri-operative antibiotic use/protocols were also assessed. The search was implemented manually. Exclusion criteria were absence of full texts or absence of information allowing to differentiate oncological and/or functional outcomes of each therapeutic approach used. RESULTS: We included 241 men from 27 retrospective studies published between 1991 and 2016; 7 were case-control and 20 were case series. We also considered 9 case reports, published between 1999 and 2016. Follow up ranged from 1 to 120 months. PCa was organ-confined and with Gleason Score ≤6 in 75.2% and 60.4%. Surgery was the most frequent treatment (n=186) with Cancer specific (CSS) and overall survival (OS) being 96,8% and 96,8%, respectively. Functional outcomes including continence and erectile function and complications were less frequently reported and generally comparable to standard RP. Other treatment modalities included radiotherapy ± androgen deprivation therapy (n=34; OS 88.2%; CSS 88.2%), androgen deprivation therapy alone (n=14; OS 42.9%; CSS 64.3%), brachytherapy (n=11: OS and CSS 100%), watchful waiting (n=4) and active surveillance (n=1). Overall no treatment-related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Limitations include low quality of the studies (LE III n=7; IV n=20), absence of standardized methods to report functional outcomes and complications and inconsistency in immunosuppression and antibiotics administration reports. CONCLUSIONS: Outcomes of PCa treatment in RTR are encouraging and do not seem inferior to those of non-RTR. RP was the most assessed approach whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High quality studies are needed as the level of evidence is low and results should be interpreted with caution. This article is protected by copyright. All rights reserved.