BERKELEY, CA (UroToday.com) - Compared to dialysis, renal transplantation significantly improves survival in patients with end-stage renal disease (ESRD). Prior to transplantation, transplant candidates undergo extensive medical evaluation which, at many institutions, includes prostate cancer screening using PSA. Although previously established in the general population, 95th percentile reference ranges have not been evaluated in patients with ESRD awaiting transplant. In a retrospective review of 775 patients with ESRD on the renal transplant waiting list, we determined age-specific references ranges and calculated cancer detection rates at specific PSA intervals.
| "Currently, we recommend aggressive prostate cancer screening in patients with ESRD awaiting renal transplant to prevent denial of a life-saving renal transplant." |
Age-specific 95th percentile reference ranges were 0-4.0 ng/mL for 40-49 (n=137), 0-5.3 ng/mL for 50-59 (n=257), 0-10.5 ng/mL for 60-69 (n=265), and 0-16.6 ng/mL for 70-79 (n=69). For PSA ranges of 2.5-4.0, 4-10, and >10 ng/ml, prostate cancer detection rates were 44%, 38%, and 67%. Prostate cancer screening is a multifaceted issue in patients with ESRD. Without establishment of a prostate cancer-free health status, transplant candidates may not be eligible for a life-saving renal transplant. Additionally, it is unclear whether prostate cancer behaves more biochemically aggressively in patients on immunosuppressive therapy.
While our study is limited by the retrospective design, the exclusion of transplant eligibility based on a diagnosis of cancer makes a randomized trial challenging. Further studies are necessary to evaluate the natural history and long-term outcomes of prostate cancer in patients on immunosuppression following renal transplantation. Currently, we recommend aggressive prostate cancer screening in patients with ESRD awaiting renal transplant to prevent denial of a life-saving renal transplant.
Written by:
Duane Baldwin, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Professor of Urology
Loma Linda University School of Medicine
Loma Linda, CA USA
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