Prostate cancer raises mortality risk in ESKD, lowers likelihood of transplant
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Researchers comparing patients on dialysis with and those without prostate cancer found the cancer increased risk for mortality and reduced the likelihood of transplant, even though transplantation improved survival by 80% for all patients.
The study, published in Kidney Medicine, included 15,554 pairs of patients with prostate cancer and controls identified through Medicare claims.
“For patients with [end-stage kidney disease] ESKD, compared to dialysis, kidney transplant is associated with reduction in mortality, improvement in quality of life, and reduction in cost. On the other hand, immunosuppression that is required after kidney transplant is associated with increased risk of cancer among solid organ transplant recipients,” Nagaraju Sarabu, MD, MPH, of the division of nephrology in the department of medicine at University Hospitals in Cleveland, Ohio, and colleagues wrote. “Studies evaluating the degree of survival benefit kidney transplant offers for ESKD patients with prostate cancer compared to those without prostate cancer have been limited. Quantifying this relative benefit is important in making decisions about treatment of prostate cancer in ESKD patients who are kidney transplant eligible.”
Sarabu and colleagues defined their objectives as twofold: first, they sought to investigate “how mortality is influenced by a diagnosis of prostate cancer and a subsequent kidney transplant.” Secondly, they assessed how a prostate cancer diagnosis might influence the time to transplant.
Men aged between 40 and 79 years were included, with researchers finding those with prostate cancer were older (48% of them were older than 70 years compared with 28% of the controls) and more likely to be Black.
Patients with prostate cancer were followed for a mean of 3.1 years, while those without the condition were followed for 3.5 years; during this time, 77.6% of patients with prostate cancer died and 77.1% of those without the disease died.
At 1, 3 and 5 years, researchers observed patient survival rates of 76%, 48% and 30%, respectively, for those with prostate cancer compared with 80%, 51% and 33%, respectively, among the control group.
Findings demonstrated that, at any of these time markers, prostate cancer was associated with an 11% higher likelihood of death (HR = 1.11).
Regarding transplantation, researchers found prostate cancer led to a 22% lower likelihood of kidney transplant and was also associated with “a modest but statistically significant delay.”
Both patients with and those without prostate cancer benefited from transplant, with an observed improvement in survival of approximately 80% for the entire study cohort.
“[F]ew prostate cancer patients died of cancer,” Sarabu and colleagues wrote. “Future studies should investigate the underpinnings of increased mortality and impact of delay in transplant in balancing risks of increased mortality associated with remaining on dialysis and benefits of avoiding progression of the cancer due to immunosuppression.”
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