358aecffd9b714f0fe719ffc830a8075 303914.pdf 5b62bff772b0baa7614f60346dd146d98ca11296 303914.pdf 583af9f93ac4c9fd708077dc260f5efd60493ad4c1270120360cf8ffec57052e 303914.pdf Title: Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort Subject: Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60–73) and 45.9 mL/min (IQR 31.5–63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48–191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02–10). The biopsy Gleason score was 8 in 12.8%; 11.6% and 6.1% patients had suspicion of cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31–106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16–0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided. Keywords: prostate cancer; renal transplant; treatment; robotic radical prostatectomy; immunosuppression Author: Giancarlo Marra, Francesco Soria, Federica Peretti, Marco Oderda, Charles Dariane, Marc-Olivier Timsit, Julien Branchereau, Oussama Hedli, Benoit Mesnard, Derya Tilki, Jonathon Olsburgh, Meghana Kulkarni, Veeru Kasivisvanathan, Cedric Lebacle, Oscar Rodriguez-Faba, Alberto Breda, Timo Soeterik, Giorgio Gandaglia, Paola Todeschini, Luigi Biancone, Paolo Gontero and on behalf of the Collaborators † Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Dec 29 08:50:00 2022 CET ModDate: Thu Dec 29 09:15:59 2022 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 274037 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- RKXKLA+VnURWPalladioL Type 1 Custom yes yes no 10 0 OYJTMT+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 BEHFBR+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 UERDMN+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 IKKWKP+CMSY10 Type 1 Builtin yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 RIJDHR+CMBSY10 Type 1 Builtin yes yes no 84 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 88 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-12-20 02:49:04 CET RepresentationInformation: 303914.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-19 11:01:54 CET Size: 274037 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 199 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Data Collection Destination: subsection.2.1 Item: Title: Outcomes Destination: subsection.2.2 Item: Title: Categorization of the Variables Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Baseline Features Destination: subsection.3.1 Item: Title: PCa Features and Treatment Destination: subsection.3.2 Item: Title: Oncological Outcomes and Survival Destination: subsection.3.3 Item: Title: Univariable Analysis Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort Author: Giancarlo Marra, Francesco Soria, Federica Peretti, Marco Oderda, Charles Dariane, Marc-Olivier Timsit, Julien Branchereau, Oussama Hedli, Benoit Mesnard, Derya Tilki, Jonathon Olsburgh, Meghana Kulkarni, Veeru Kasivisvanathan, Cedric Lebacle, Oscar Rodriguez-Faba, Alberto Breda, Timo Soeterik, Giorgio Gandaglia, Paola Todeschini, Luigi Biancone, Paolo Gontero and on behalf of the Collaborators † Subject: Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60 73) and 45.9 mL/min (IQR 31.5 63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48 191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02 10). The biopsy Gleason score was 8 in 12.8%; 11.6% and 6.1% patients had suspicion of cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31 106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16 0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided. Keywords: prostate cancer; renal transplant; treatment; robotic radical prostatectomy; immunosuppression Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Dec 29 08:50:00 CET 2022 ModDate: Thu Dec 29 09:15:59 CET 2022 ID: 0x3ef516825451cf6008b8991fc2d2baa9, 0x3ef516825451cf6008b8991fc2d2baa9 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: BEHFBR+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: BEHFBR+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: RIJDHR+CMBSY10 FontSubset: true FirstChar: 21 LastChar: 21 FontDescriptor: FontName: RIJDHR+CMBSY10 Flags: Symbolic FontBBox: -26, -940, 1332, 825 FontFile: true Font: BaseFont: UERDMN+URWPalladioL-Ital FontSubset: true FirstChar: 37 LastChar: 122 FontDescriptor: FontName: UERDMN+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: RKXKLA+VnURWPalladioL FontSubset: true FirstChar: 160 LastChar: 230 FontDescriptor: FontName: RKXKLA+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: IKKWKP+CMSY10 FontSubset: true FirstChar: 20 LastChar: 21 FontDescriptor: FontName: IKKWKP+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: OYJTMT+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 151 FontDescriptor: FontName: OYJTMT+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 61, 315, 152, 324 Annotation: Subtype: Link Rect: 34, 305, 152, 312 Annotation: Subtype: Link Rect: 34, 293, 104, 300 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 152, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 378, 661, 389, 674 Annotation: Subtype: Link Rect: 110, 17, 261, 28 Annotation: Subtype: Link Rect: 410, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 412, 87, 431 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 453, 568, 460, 576 ActionDest: 98 Annotation: Subtype: Link Rect: 461, 568, 468, 576 ActionDest: 98 Annotation: Subtype: Link Rect: 219, 530, 226, 539 ActionDest: 98 Annotation: Subtype: Link Rect: 229, 530, 236, 539 ActionDest: 98 Annotation: Subtype: Link Rect: 257, 392, 264, 401 ActionDest: 98 Annotation: Subtype: Link Rect: 264, 392, 271, 401 ActionDest: 98 Annotation: Subtype: Link Rect: 411, 354, 418, 363 ActionDest: 98 Annotation: Subtype: Link Rect: 418, 354, 425, 363 ActionDest: 98 Annotation: Subtype: Link Rect: 349, 329, 356, 338 ActionDest: 98 Annotation: Subtype: Link Rect: 356, 329, 363, 338 ActionDest: 98 Annotation: Subtype: Link Rect: 377, 304, 384, 313 ActionDest: 98 Annotation: Subtype: Link Rect: 385, 304, 397, 313 ActionDest: 98 Annotation: Subtype: Link Rect: 531, 279, 543, 288 ActionDest: 98 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 316, 279, 323, 291 ActionDest: 69 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 212, 69, 219, 81 ActionDest: 75 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 372, 82, 379, 94 ActionDest: 78 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 319, 237, 326, 249 ActionDest: 81 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 357, 105, 369, 114 ActionDest: 98 Annotation: Subtype: Link Rect: 265, 67, 272, 76 ActionDest: 98 Annotation: Subtype: Link Rect: 272, 67, 279, 76 ActionDest: 98 Annotation: Subtype: Link Rect: 280, 67, 292, 76 ActionDest: 98 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 343, 597, 355, 606 ActionDest: 98 Annotation: Subtype: Link Rect: 414, 459, 421, 468 ActionDest: 98 Annotation: Subtype: Link Rect: 422, 459, 429, 468 ActionDest: 98 Annotation: Subtype: Link Rect: 430, 459, 441, 468 ActionDest: 98 Annotation: Subtype: Link Rect: 544, 434, 556, 443 ActionDest: 98 Annotation: Subtype: Link Rect: 300, 346, 312, 355 ActionDest: 98 Annotation: Subtype: Link Rect: 328, 334, 340, 343 ActionDest: 98 Annotation: Subtype: Link Rect: 340, 334, 352, 343 ActionDest: 98 Annotation: Subtype: Link Rect: 333, 321, 340, 330 ActionDest: 98 Annotation: Subtype: Link Rect: 340, 321, 347, 330 ActionDest: 98 Annotation: Subtype: Link Rect: 438, 296, 450, 305 ActionDest: 98 Annotation: Subtype: Link Rect: 232, 95, 239, 104 ActionDest: 98 Annotation: Subtype: Link Rect: 239, 95, 246, 104 ActionDest: 98 Annotation: Subtype: Link Rect: 247, 95, 259, 104 ActionDest: 98 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 301, 535, 308, 544 ActionDest: 98 Annotation: Subtype: Link Rect: 309, 535, 316, 544 ActionDest: 98 Annotation: Subtype: Link Rect: 536, 395, 560, 406 Annotation: Subtype: Link Rect: 165, 383, 392, 394 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 419, 587, 457, 598 Annotation: Subtype: Link Rect: 463, 587, 499, 598 Annotation: Subtype: Link Rect: 127, 565, 164, 575 Annotation: Subtype: Link Rect: 170, 565, 206, 575 Annotation: Subtype: Link Rect: 127, 531, 165, 541 Annotation: Subtype: Link Rect: 171, 531, 207, 541 Annotation: Subtype: Link Rect: 255, 495, 293, 506 Annotation: Subtype: Link Rect: 362, 472, 400, 483 Annotation: Subtype: Link Rect: 406, 472, 442, 483 Annotation: Subtype: Link Rect: 195, 438, 232, 449 Annotation: Subtype: Link Rect: 238, 438, 274, 449 Annotation: Subtype: Link Rect: 95, 416, 133, 426 Annotation: Subtype: Link Rect: 139, 416, 175, 426 Annotation: Subtype: Link Rect: 364, 380, 402, 391 Annotation: Subtype: Link Rect: 408, 380, 444, 391 Annotation: Subtype: Link Rect: 59, 347, 96, 357 Annotation: Subtype: Link Rect: 102, 347, 138, 357 Annotation: Subtype: Link Rect: 275, 323, 313, 334 Annotation: Subtype: Link Rect: 319, 323, 355, 334 Annotation: Subtype: Link Rect: 442, 300, 479, 311 Annotation: Subtype: Link Rect: 486, 300, 522, 311 Annotation: Subtype: Link Rect: 520, 277, 557, 288 Annotation: Subtype: Link Rect: 59, 266, 95, 276 Annotation: Subtype: Link Rect: 59, 243, 96, 253 Annotation: Subtype: Link Rect: 102, 243, 138, 253 Annotation: Subtype: Link Rect: 59, 209, 96, 219 Annotation: Subtype: Link Rect: 102, 209, 138, 219 Annotation: Subtype: Link Rect: 59, 174, 96, 184 Annotation: Subtype: Link Rect: 102, 174, 138, 184 Annotation: Subtype: Link Rect: 131, 151, 168, 161 Annotation: Subtype: Link Rect: 175, 151, 211, 161 Checksum: 13ff6deb Type: CRC32 Checksum: 358aecffd9b714f0fe719ffc830a8075 Type: MD5 Checksum: 5b62bff772b0baa7614f60346dd146d98ca11296 Type: SHA-1 Checksum: 583af9f93ac4c9fd708077dc260f5efd60493ad4c1270120360cf8ffec57052e Type: SHA-256