The Prevalence of Prostate Cancer in Organ Donors With Increased Prostate-Specific Antigen

Abstract

Elevated prostate-specific antigen (PSA) levels were found in 139 of 472 kidney donors from our transplant center tested between 2009 and 2022, representing 29%. The mean age of these donors was 47.3 years. PSA values ranged from 2.8 to 160.4 ng/mL (mean 13.9 ng/mL). The recommended range is <2.5 ng/mL. Prostate histopathologic examination was performed in 38 of the 139 (27%). We found 14 cases of prostate cancer (PCa), with Gleason 3+3 in 8 cases, 3+4 in 4 cases (one donor disqualification), 1 case Gleason 4+3 (donor disqualification), and 1 case Gleason 4+5 (donor disqualification). Thirty-three patients met the criteria, were aged ≥50 years, and had a PSA level >10 mg/mL. Of these, prostate histopathologic examination was performed in 24 cases. PCa was found in 10 cases (42%). There was no difference between donors ≥50 years of age, with PSA>10 ng/mL with and without pathomorphologic diagnosis of PCa regarding age (mean 60.4 vs 60.6 years), creatinine clearance according to the Cockroft-Gaulta formula (mean 101.6 vs 94.8 mL/min) and PSA levels (mean 34.1 vs 29.3 ng/mL). Among other donors with PCa, 3 were <50 years with PSA >10 ng/mL, and 1 was ≥50 years with PSA<8 ng/mL. Kidneys from donors with PCa were transplanted into 10 men and 9 women. Follow-up time was 1 to 10 years. No cases of PCa transmission were reported. One of the recipients died of neoplasm-breast cancer. Donors ≥50 years of age with PSA>10 ng/mL have a higher risk for Pca. Accepting donors with Pca (Gleason 3+3 and 3+4) possesses minimal risk for transmission. All donors ≥50 years with increased PSA require further diagnostic procedures (eg, digital rectal examination, ultrasound, and eventually histologic examination).