Screening for Prostate Cancer in Kidney Transplant Candidates may be Detrimental
Concerned about how prostate cancer screening could affect the time to transplantation and transplant outcomes for renal transplant candidates, Nicole Turgeon, MD, associate professor of surgery, Emory Division of Transplantation, and a team of Emory kidney transplant and urology researchers retrospectively analyzed information on 3782 male patients undergoing kidney transplant evaluations at Emory between Jan. 1, 2000 and Jan. 1, 2011. The data was primarily sourced from Emory's Organ Transplant Tracking Record.
The findings were published in the Journal of the American Society of Nephrology on Dec. 23, 2015, and determined that PSA (prostate-specific antigen) screening for prostate cancer in male kidney transplant candidates may be more harmful than protective because it does not appear to prolong their survival and may actually interfere with the transplant process.
"Screening recommendations for prostate cancer remain controversial, and no specific guidelines exist for screening in renal transplant candidates, though transplant centers generally rigorously screen candidates for potential malignancies to ensure that there are no contraindications to receiving a transplant," says Dr. Turgeon. "A PSA level may be elevated in a variety of disease processes, not only prostate cancer."
Upon analysis, the investigators concluded that PSA screening was not associated with improved patient survival after transplantation; that PSA screening increased the time to listing and transplantation for candidates under 70 years old whose PSA tests indicated elevated levels; and that compared with candidates who were not screened, PSA-screened candidates had a reduced likelihood of receiving a transplant regardless of their PSA level.
The researchers also found that a positive PSA screening result led to a diagnosis of prostate cancer in only 26.4 percent of candidates, although 75.8 percent of candidates with a positive PSA screening result did not receive a transplant. Additionally, a false-positive result, which occurred 74.6 percent of the time, significantly delayed the listing for transplantation by nearly a year while candidates underwent further evaluation, without clear guidelines on how to manage an isolated elevated PSA level, and decreased the transplantation rate by approximately 50 percent.
"The negative effect on quality of life while awaiting a transplant may outweigh the benefits obtained by correctly diagnosing and treating prostate cancer, which offers no survival benefits to these patients," says Dr. Turgeon. "The ability to lead a normal life off dialysis is a privilege that many transplant candidates value most highly. Delaying that transplant by more than two years, in some cases, is a substantial effect, especially because two-thirds of patients die within five years of beginning dialysis. This is considerably higher than the 1.1 percent five-year mortality rate for prostate cancer."
"Utility of Prostate Cancer Screening in Kidney Transplant Candidates." Gerardo Vitiello, MD, Blayne Sayed, MD, Marla Wardenburg, MD, Sebastian Perez, MSPH, Christopher Keith, BS, Daniel Canter, MD, Kenneth Ogan, MD, Thomas Pearson, MD, DPhil, Nicole Turgeon, MD. Journal of the American Society of Nephrology. 2015 Dec. 23.