Authors: Liauw SL, Ham SA, Das LC, Rudra S, Packiam V, Koshy M, Weichselbaum RR, Becker YT, Bodzin A, Eggener SE
Title: Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis.
Journal: J Natl Cancer Inst :-
Date: 2019 Nov 15
PubMed ID: 31728517
Abstract: BACKGROUND: Immunosuppressive regimens associated with organ transplantation increase the risk of developing cancer. Transplant candidates and recipients with prostate cancer are often treated, even if low risk features would ordinarily justify active surveillance. METHODS: Using SEER-Medicare, we identified 163,676 men aged ≥66, diagnosed with non-metastatic prostate cancer. History of solid organ transplant was identified using diagnosis or procedure codes. A propensity score-matched cohort was identified by matching transplanted men to non-transplanted controls by age, race, region, year, T-stage, grade, comorbidity and cancer therapy. Fine-Gray competing risk models assessed associations between transplant status and prostate cancer-specific (PCSM) and overall mortality (OM). RESULTS: We identified 620 men (0.4%) with transplant up to 10 years before (n = 320) or 5 years after (n = 300) prostate cancer diagnosis and matched them to 3,100 men. At 10-years, OM was 55.7% and PCSM was 6.0% in the transplant cohort, compared to 42.4% (p < 0.001) and 7.6% (p = 0.70) in the non-transplant cohort, respectively. Adjusted models showed no difference in PCSM for transplanted men (HR = 0.88, 95% CI = 0.61-1.27, p = 0.70) or differences by prostate cancer therapy. Among 334 transplanted men with T1-2N0, well/moderately differentiated 'low-risk' prostate cancer, PCSM was similar for treated and untreated men (HR = 0.92, 95% CI = 0.47 to 1.81). CONCLUSIONS: Among men age ≥66 y with prostate cancer, an organ transplant is associated with higher OM but no observable difference in PCSM. These findings suggest men with prostate cancer and previous or future organ transplantation should be managed per usual standards of care, including consideration of active surveillance for low-risk cancer characteristics.