Screening Kidney Transplant Recipients For Prostate Cancer May Not Be Beneficial

Gerardo Vitiello

Dr. Vitiello Interview with:
Gerardo Vitiello, MD
Emory University School of Medicine
Emory Transplant Center
NYU Langone Medical Center
Department of Surgery 

Medical Research: What is the background for this study? What are the main findings?

Dr. Vitiello:   Screening for prostate cancer with prostate specific antigen (PSA) levels is highly controversial, as it is a non-specific marker for prostate cancer. A PSA level may be elevated in a variety of disease processes (not only prostate cancer), and even in the general population, the benefit of early intervention for prostate cancer is unclear. In contrast, end stage renal disease (ESRD), where patients no longer have renal function and require dialysis, is a major health problem with a huge impact on a patient’s quality of life. The only cure for ESRD is kidney transplantation, which has been shown to have an enormous health and quality of life benefit for transplant recipients. Transplant centers have rigorously screened candidates for potential malignancy prior to transplantation to ensure that there are no contraindications to receiving a transplant. For the first time, we demonstrate that screening for prostate cancer in kidney transplant candidates is not beneficial, and may actually be harmful, since it delays time to transplant and reduces a patient’s chance of receiving a transplant without an apparent benefit on patient survival.

Medical Research: What should clinicians and patients take away from your report?

Dr. Vitiello:   We were hoping to demonstrate that prostate cancer screening is not a “neutral” intervention in the transplant population. In other words, it may be helpful or it may be harmful, but we need to have data driven guidelines that support our medical strategies in complicated patients. We discovered that prostate cancer screening not only prolonged waiting times for kidney transplant candidates, but candidates were also less likely to receive transplants. Furthermore, patients who underwent prostate cancer screening did not seem to survive any longer than those who did not undergo screening, calling into question the non-standardized practice of prostate cancer screening in kidney transplant candidates.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Vitiello:    The main limitation of this study is that it is a single-center, retrospective study. Since it is a single center, the results may not be generalizable to the entire transplant population. As it is retrospective, there may be non-random factors leading to prostate cancer screening that we cannot easily identify. Additional multi-center prospective randomized trials are needed to develop screening guidelines.

*Dr. Vitiello completed his medical education at Emory University School of Medicine and now is a surgical resident at NYU Langone Medical Center.


Utility of Prostate Cancer Screening in Kidney Transplant Candidates

Gerardo A. Vitiello, Blayne A. Sayed, Marla Wardenburg, Sebastian D. Perez,Christopher G. Keith, Daniel J. Canter, Kenneth Ogan, Thomas C. Pearson,and Nicole Turgeon

JASN ASN.2014121182; published ahead of print December 23, 2015,doi:10.1681/ASN.2014121182

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