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Adverse Occurrence type:
Most recent risk assessment for prostate cancer (Council of Europe, 2022): If Gleason score is available, e.g., prostate diagnostics have been initiated a few days before organ procurement, then small intra-prostatic, low-grade (Gleason score ≤ 6) tumours are considered minimal-risk; intra-prostatic tumours with Gleason score 7 are considered low-to-intermediate risk; and intra-prostatic (pT2c) tumours with Gleason score > 7 are considered high-risk. Histological examination of the entire prostate with a valid grading of the tumour is time-consuming and the results might not always be available before an organ is transplanted. Donors with extra-prostatic tumour extension should be unequivocally excluded from the donation process as an unacceptable risk. Prostate cancer in the donor history: The acceptable time intervals for complete remission of prostate cancer are strongly correlated with stage and Gleason grade of the tumour. Donors with a history of curatively treated prostate cancer ≤ pT2 (tumour confined to prostate) and Gleason 3 + 3, as well as donors with very small prostate cancers and Gleason 3 + 3 under ‘active surveillance’, can be accepted for organ donation as minimal transmission risk at any time after diagnosis with the prerequisite of a frequently performed and non-suspicious follow-up. Prostate cancer < pT2 (confined to the prostate) and Gleason grade < 7 after curative treatment and cancer-free period > 5 years is considered minimal-risk. Higher stages/grades and/or shorter cancer-free periods require an individual risk assessment. A history of extra-¬prostatic tumour extension poses a high risk for transmission. In any case, current PSA values should be obtained to compare to former ones and to assess the actual situation.
Time to detection:
No own data are presented by the authors in this 15 year-literature review: there has only been reported one transimission by the donor to the heart recipient that was detected 10 months after transplant.The donor had a locally advanced and metastatic prostate cancer (Loh et al. JAMA 1997)
Alerting signals, symptoms, evidence of occurrence:
It was a late diagnosed prostate cancer finally classified pT3N+ on iliac lymph nodes discovered in the donor at the end of the procurement, while the heart transplant had already been performed. Transmission was discovered 10 months after the heart transplant with bone metastases and the patient died in the year following the diagnosis.
Demonstration of imputability or root cause:
Details must be extracted from original references.
Suggest new keywords:
PSA (prostate specific antigen)
Doerfler A, Tillou X, Le Gal S, Desmonts A, Orczyk C, Bensadoun H. Prostate cancer in deceased organ donors: a review. Transplant Rev (Orlando). 2014 Jan;28(1):1–5.
Pls, confirm the keywords. It was difficult to assess this review. 16 articles were selected for this review, aiming to estimate the risk of prostate cancer transmission in relation with organ procurement. July 31, 2018 second review done (Kerstin)
Expert comments for publication:
The incidence of prostate cancer is increasing with age and undiagnosed localized prostate cancer is therefore expected in a certain percentage of elder male donors without reported transmissions so far. Confirming the diagnosis during procurement in suspicious cases is difficult as it requires thorough examination of the prostate which will mostly not be available in due time. Nevertheless, the authors conclude from the literature review that the transmission risk of prostate cancer by a transplanted organ seems to be anecdotal. Only 1 case has been reported, while more than 120 solid organ transplants from deceased donors with a proven prostate cancer have not induced transmission. The usefulness of PSA testing in organ donors is discussed and found uncertain in the analyzed studies where in the majority of elevated PSA findings the patient had no prostate cancer and vice versa. The authors emphasize to put special attention to cases of donor PSA levels >20 ng/ml and to perform a thorough inspection of the donor´s body cavities during procurement in every donor. CAVE: The one and only reported transmission case has been referred to in several registries.