Low-risk prostate cancer in kidney failure patients being worked-up for a kidney transplant

What is it about?

It is unclear how to deal with low-risk prostate cancer in kidney failure patients being worked-up for a kidney transplant. We developed a model simulating the clinical course of thousands of such patients and investigated several management strategies [definitive treatment (surgery or radiation therapy) and listing after a waiting period of 2 years, definitive treatment and immediate listing, active surveillance and listing after a waiting period of 2 years, and active surveillance and immediate listing] to identify the best strategy from an integrative healthcare perspective. Our study suggests that active surveillance and immediate listing yields the highest amount of quality-adjusted life years.

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Why is it important?

It is a general rule in transplantation medicine that every active malignancy is an absolute contraindication for transplantation. This rule is challenged by active surveillance-eligible prostate cancer as these patients do formally not require definitive treatment (i.e. surgery/radiation therapy). As a result, interdisciplinary treatment teams caring for these patients therefore often face the challenge of balancing the benefits of early kidney transplantation and the risk of metastatic progression. Our study suggests that active surveillance and immediate listing yields the highest amount of quality-adjusted life years and therefore supports the decision-making in interdisciplinary transplantation boards.

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