title: Utility of Prostate Cancer Screening in Kidney Transplant Candidates.
abstract: Screening recommendations for prostate cancer remain controversial, and no specific guidelines exist for screening in renal transplant candidates. To examine whether the use of prostate-specific antigen (PSA)-based screening in patients with ESRD affects time to transplantation and transplant outcomes, we retrospectively analyzed 3782 male patients ≥18 years of age undergoing primary renal transplant evaluation during a 10-year period. Patients were grouped by age per American Urological Association screening guidelines: group 1, patients <55 years; group 2, patients 55-69 years; and group 3, patients >69 years. A positive screening test result was defined as a PSA level >4 ng/ml. We used univariate analysis and Cox proportional hazards models to identify the independent effect of screening on transplant waiting times, patient survival, and graft survival. Screening was performed in 63.6% of candidates, and 1198 candidates (31.7%) received kidney transplants. PSA screening was not associated with improved patient survival after transplantation (P=0.24). However, it did increase the time to listing and transplantation for candidates in groups 1 and 2 who had a positive screening result (P<0.05). Furthermore, compared with candidates who were not screened, PSA-screened candidates had a reduced likelihood of receiving a transplant regardless of the screening outcome (P<0.001). These data strongly suggest that PSA screening for prostate cancer may be more harmful than protective in renal transplant candidates because it does not appear to confer a survival benefit to these candidates and may delay listing and decrease transplantation rates.
authors.affiliation: Department of Transplant Surgery and Department of Surgery, NYU Langone Medical Center, New York, New York;
authors.forename: Gerardo A
authors.initials: GA
authors.lastname: Vitiello
authors.affiliation: Department of Transplant Surgery and.
authors.forename: Blayne A
authors.initials: BA
authors.lastname: Sayed
authors.affiliation: Department of Transplant Surgery and Department of Urology, University of Florida, Gainesville, Florida; and.
authors.forename: Marla
authors.initials: M
authors.lastname: Wardenburg
authors.affiliation: Department of Transplant Surgery and.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.affiliation: Department of Transplant Surgery and.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Keith
authors.affiliation: Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.affiliation: Department of Urology, Emory University, Atlanta, Georgia;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.affiliation: Department of Transplant Surgery and.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Pearson
authors.affiliation: Department of Transplant Surgery and nturgeo@emory.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Turgeon
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: PSA screening; kidney transplant; prostate cancer