Registry series: New Italian guidelines for donors with prostate cancer (2010)

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Adverse Occurrence type: 
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Estimated frequency: 
(Council of Europe, 2018): If recent Gleason score is available, 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 donation and represent an unacceptable risk. The acceptable time intervals for complete remission of historical prostate cancer are correlated to 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 confined to the prostate and Gleason grade 7 or less after curative treatment and cancer-free period > 5 years is considered minimal risk. Higher stages and higher Gleason grades require an individual risk assessment. A history of extra-prostatic tumour extension poses a high risk for transmission.
Time to detection: 
N/A: No reports of tumor transmission in 6 liver recipients from donors with intraprostatic carcinoma during 12-56 month followup.
Alerting signals, symptoms, evidence of occurrence: 
Demonstration of imputability or root cause: 
Groups audience: 
Suggest new keywords: 
Registry Series
Deceased donor
Liver transplant
Liver recipient
Histological examination
Prostate adenocarcinoma/carcinoma
Therapy not discussed
Suggest references: 
D'Errico-Grigioni A, Fiorentino M, Vasuri F, Corti B, Ridolfi L, Grigioni WF; Pathology Unit for organ safety of the F. Addarii Institute, Bologna, Bagni A, Pirini MG, Malvi D, Fabbrizio B, Caprara G, Alvaro N. Expanding the criteria of organ procurement from donors with prostate cancer: the application of the new Italian guidelines. Am J Transplant. 2010 Aug;10(8):1907-11. doi: 10.1111/j.1600-6143.2010.03198.x. PMID: 20659096.
Uploaded MN 5/7/22 first review CLFF 5/27/22 (I hope I am not too restrictive with conclusions) Second review MN 5/28
Expert comments for publication: 
This 2010 report discusses the Italian guidelines for assessing donors for prostate carcinoma, and compares the periods before and after 2005. Before 2005, criteria were more restrictive, leading to frequent prostate frozen section analysis and exclusion of potential donors. After 2005, criteria were relaxed, with low grade intraprostatic carcinoma considered as standard risk. Combined with nomogram analysis and a central national reviewer, this led to an increase in donor organs, decrease in frozen section analysis at time of transplant, and no increase in tumor transmission. See also the current Council of Europe guidelines for prostate cancer (above).