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Master Thesis

Surdiagnostic du cancer de la prostate en transplantation d'organes solides : leçon des trente dernières années

Abstract : Introduction. Prostate cancer (PC) is the most common neoplasia in men. With aging of solid organ transplant recipients (STOR), its incidence is likely to increase. The aim of this study was to analyse PC screening results retrospectively in renal (RTR), hepatic (HTR) and cardiac transplant recipients (CTR). Methods. A retrospective monocentric study of PC diagnosed in renal, hepatic or cardiac transplanted patients since 1989 was performed. All the patients were followed annually by digital rectal examination and PSA dosage. Results. 57 PC were diagnosed in 1 565 men SOR (3,6%): 35 RTR, 15 HTR, and 7 CTR. Standard incidence ratio (SIR) was 41.9. Mean age at the diagnostic was 64.5 (60.5-69.2) years old. Mean time between transplantation and PC diagnostic was 95.7 (39.0-139.5) months. Median PSA rate was 7.0 (6,2-13) ng/mL. Clinical stages were T1, T2, and T3 respectively for 29, 22 and 6 patients. Diagnosis was done by screening, chips after transurethral resection, after prostatitis and bone pain in respectively 55, 3, 1 and 1 patients. 2 patients were treated by active surveillance. 39 (68%) patients (25 RTR, 11 HTR and 3 CTR) were treated by radical prostatectomy (RP). Histological results were 30pT2 and 9pT3, with 7 positive surgical margins. Gleason score (GS) was 5, 6, 7, 8 and 9 in respectively in 2, 24, 11, 1 and 1 patient. Median follow up was 85.2 months (46.1-115.0). 23 (40.4%) patients died: 2 (3.6%) RTR and 1 (1.8%) CTR from their PC. Conclusion. Systematic screening in male SOTR after 50 years old could not be recommended. In the last three decades we diagnosed too many low risk prostate cancers strongly increasing the SIR but failing to decrease prostate cancer related mortality. SOTR should undergo individual screening with prior MRI when PSA rates are high. Management should not be different from that of the general population.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02942313
Contributor : Ufr Santé Unicaen <>
Submitted on : Thursday, September 17, 2020 - 5:01:21 PM
Last modification on : Friday, January 29, 2021 - 1:08:22 PM
Long-term archiving on: : Friday, December 18, 2020 - 6:17:58 PM

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  • HAL Id : dumas-02942313, version 1

Citation

Thibaut Waeckel. Surdiagnostic du cancer de la prostate en transplantation d'organes solides : leçon des trente dernières années. Médecine humaine et pathologie. 2020. ⟨dumas-02942313⟩

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