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Adverse Occurrence type:
(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:
Alerting signals, symptoms, evidence of occurrence:
Demonstration of imputability or root cause:
Suggest new keywords:
Donor cancer without transmission
Single center series
Skalski M, Gierej B, Nazarewski L, Ziarkiewicz-Wroblewska B, Zieniewicz K. Prostate Cancer in Deceased Organ Donors: Loss of Organ or Transplantation With Active Surveillance. Transplant Proc. 2018;50(7):1982-4.
Please also clone record under: Adverse occurrence type: Unsuitable MPHO released for clinical use- no harm - OK (EP)
Expert comments for publication:
This single center series reported 8 patients who received liver transplants from donors who were ultimately found to have prostate carcinoma. In all cases the Gleason score was 3+3 and tumor was restricted to the prostate. One recipient died of unrelated causes after transplant; no tumor transmission was found in the other 7 (followup 2-24 months, median 6 months). The authors suggest that these organs from early stage prostate cancer donors are suitable for transplant and that the recipients should be followed. They note that PSA has shortcomings in predicting prostate cancer, and biopsy at the time of transplant does not have a well-defined role.