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PROSCA 2020 case 5 - Stranne

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What would Johan Stranne do?


A transplanted patient is put on immune suppression. Therefore, the work-up before the transplantation is performed includes the exclusion of any concomitant tumours that could start growing once the immune system is suppressed. Unfortunately, this pre-transplantation work-up may lead to the diagnosis of a low risk prostate cancer. Without the immune suppression, it would be unlikely to need curative treatment, but it would lead to the demand for curative treatment by the transplant surgeons. Some recent studies indicate that a more conservative approach, with active surveillance, likely is a safe strategy [1,2]. Furthermore, if the tumour starts growing at a later stage it is likely that curative treatment, when the patient has a functioning kidney, would be less hazardous.

References:
  • Clark C et al. Active surveillance for prostate cancer in patients being activated for renal transplantation. Eur Urol Open Science 2020;19(2):e1919(abs.PT154)
  • Ola Bratt O et al. Prostate cancer in kidney transplant recipients - a nationwide register study. BJU Int 2020;125(5):679-85
 

What would Johan Stranne do?

A transplanted patient is put on immune suppression. Therefore, the work-up before the transplantation is performed includes the exclusion of any concomitant tumours that could start growing once the immune system is suppressed. Unfortunately, this pre-transplantation work-up may lead to the diagnosis of a low risk prostate cancer. Without the immune suppression, it would be unlikely to need curative treatment, but it would lead to the demand for curative treatment by the transplant surgeons. Some recent studies indicate that a more conservative approach, with active surveillance, likely is a safe strategy [1,2]. Furthermore, if the tumour starts growing at a later stage it is likely that curative treatment, when the patient has a functioning kidney, would be less hazardous.

References:
  • Clark C et al. Active surveillance for prostate cancer in patients being activated for renal transplantation. Eur Urol Open Science 2020;19(2):e1919(abs.PT154)
  • Ola Bratt O et al. Prostate cancer in kidney transplant recipients - a nationwide register study. BJU Int 2020;125(5):679-85
I hope you can join us during the live panel discussion of virtual PROSCA 2020 on 14 October to further discuss these data.
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