Recommendations for patients with prostate cancer who wish to undergo a kidney transplant

Abstract

Over the past half a century, kidney transplants have increased significantly and more patients that are elderly are receiving kidney transplants. As a result, the eligibility of patients with prostate cancer who wish to receive a kidney transplant has become a significant issue facing the transplant community. Many questions have arisen because prostate cancer is an extremely variable disease that many times do not harm the patients but at other times, can cause the death of the patient.

If a patient has prostate cancer, should he be allowed to receive a kidney transplant? Should he receive the transplant after treatment for prostate cancer or without such treatment? How should the transplant community determine his eligibility? Most agree that those with high-risk prostate cancer should be treated first and have a waiting period prior to kidney transplant. Almost all low-risk prostate cancer patients are candidates for active surveillance. More and more urologists are doing active surveillance for favorable intermediate risk prostate cancer patients. We believe that all patients who are reasonable candidates for active surveillance based on the National Comprehensive Cancer Network (NCCN) guidelines for prostate cancer are reasonable candidates for kidney transplant without treatment for prostate cancer. We recommend using a combination of shared-decision making that involves prostate cancer risk-stratification as well as adjunctive tests such as imaging with multiparametric MRI (mpMRI) and genomic testing such as Decipher, Oncotype DX or Polaris, in order to inform whether or not patients with prostate cancer can receive a kidney transplant without treatment for prostate cancer.