Radical retropubic prostatectomy after orthotopic liver transplantation

Increased risk of postoperative in-hospital complications after radical prostatectomy in patients with prior organ transplant

BACKGROUND

To analyze postoperative, in-hospital, complication rates in patients with organ transplantation before radical prostatectomy (RP).

METHODS

From National Inpatient Sample (NIS) database (2000-2015) prostate cancer patients treated with RP were abstracted and stratified according to prior organ transplant versus nontransplant. Multivariable logistic regression models predicted in-hospital complications.

RESULTS

Of all eligible 202,419 RP patients, 216 (0.1%) underwent RP after prior organ transplantation. Transplant RP patients exhibited higher proportions of Charlson comorbidity index ≥2 (13.0% vs. 3.0%), obesity (9.3% vs. 5.6%, both p < 0.05), versus to nontransplant RP. Of transplant RP patients, 96 underwent kidney (44.4%), 44 heart (20.4%), 40 liver (18.5%), 30 (13.9%) bone marrow, <11 lung (<5%), and <11 pancreatic (<5%) transplantation before RP. Within transplant RP patients, rates of lymph node dissection ranged from 37.5% (kidney transplant) to 60.0% (bone marrow transplant, p < 0.01) versus 51% in nontransplant patients. Regarding in-hospital complications, transplant patients more frequently exhibited, diabetic (31.5% vs. 11.6%, p < 0.001), major (7.9% vs. 2.9%) cardiac complications (3.2% vs. 1.2%, p = 0.01), and acute kidney failure (5.1% vs. 0.9%, p < 0.001), versus nontransplant RP. In multivariable logistic regression models, transplant RP patients were at higher risk of acute kidney failure (odds ratio [OR]: 4.83), diabetic (OR: 2.81), major (OR: 2.39), intraoperative (OR: 2.38), cardiac (OR: 2.16), transfusion (OR: 1.37), and overall complications (1.36, all p < 0.001). No in-hospital mortalities were recorded in transplant patients after RP.

CONCLUSIONS

Of all transplants before RP, kidney ranks first. RP patients with prior transplantation have an increased risk of in-hospital complications. The highest risk, relative to nontransplant RP patients appears to acute kidney failure.

Robot assisted laparoscopic prostatectomy in liver transplant recipient

Robotic assisted laparoscopic prostatectomy (RALP) in liver transplant recipients (LTRs) is not well documented. We present two cases of RALP in LTRs with localized prostate cancer (PCa). In both cases, a transperitoneal approach was used, and they were successfully completed without perioperative complications. Thus, RALP seems to be a feasible, safe and effective treatment for PCa in LTRs. Significant modifications to the surgical technique do not seem to be required, and patient optimization in preparation for surgery remains the key factor. History of liver transplant should not discourage embarking in a RALP in Centers with adequate robotic expertise.

Prostate cancer screening and treatment in the transplant population: current status and recommendations

PURPOSE

We reviewed the current status of and recommendations for prostate cancer screening and treatment in the solid organ transplant population.

MATERIALS AND METHODS

We performed a MEDLINE search to identify published data regarding prostate cancer screening, risk, treatment and outcomes in the solid organ transplant population. The literature was reviewed and summarized.

RESULTS

Most data regarding outcomes of prostate cancer treatment in the transplant population are limited to case reports and small series, and primarily involve renal insufficiency. It does not appear that the development or natural history of prostate cancer is significantly affected by organ failure or subsequent transplantation. Thus, prostate specific antigen testing and screening protocols can be extrapolated from the general population. However, the balance of comorbid diseases and estimated limitations in life expectancy must be carefully considered, and emphasis should be placed on risk assessment. Prostatectomy appears to be feasible with outcomes comparable to those in the non-transplant population, while data regarding the use of radiation therapy are limited.

CONCLUSIONS

The expansion of organ transplant criteria, including older donors and recipients, combined with improved allograft survival has enhanced the relevance of prostate cancer screening and treatment in this group. Greater awareness of the issues surrounding prostate cancer incidence, detection and natural history should promote improved data collection, screening and treatment of prostate cancer in the transplant population.

Serum prostate-specific antigen levels in older men with or at risk of HIV infection

OBJECTIVES

The aim of the study was to determine the rate of, and factors associated with, elevated prostate-specific antigen (PSA) levels in older men with or at risk of HIV infection.

METHODS

Using a cross-sectional analysis, we interviewed 534 men > or =49 years old at risk for HIV infection on demographics, behaviours and medical history. Laboratory testing included serum PSA level and HIV serology, and T-cell subsets for those who were HIV seropositive. Elevated PSA level was defined as >4.0 ng/mL, and men with elevated PSA levels were referred for urological evaluation.

RESULTS

Fifteen per cent of men were white, 55% black, and 23% Hispanic; median age was 53 years (range 49-80 years); 74% were sexually active; 65% currently smoked cigarettes; and 16% had taken androgens. Among 310 HIV-positive men, CD4 counts were >500 cells/microL in 31%, 200-500 cells/microL in 51%, and <200 cells/microL in 19%. Twenty men (4%) had elevated PSA. On univariate analysis, only older age was significantly associated with elevated PSA, and there was no significant difference in the number of men with elevated PSA between HIV-positive and HIV-negative men (nine of 310 vs 11 of 224; P = 0.28). On multivariate analysis, older age remained the only variable associated with elevated PSA level [reference group < or =50 years; adjusted odds ratio (OR(adj)) 1.0 for age 51-60 years; OR(adj) 5.9 (95% confidence interval 1.2-30.1) for age > or =61 years] adjusted for HIV status, family history of prostate cancer, and androgen use.

CONCLUSIONS

Among older men, PSA levels increased with age but did not differ by HIV status. The clinical use of PSA levels in older men currently do not need to be modified for those with HIV infection.