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BACKGROUND: For most cancers, a two- to five-year period with no evidence of disease must be demonstrated before organ transplantation. The natural history of prostate cancer is unique both because of extensive pre-treatment screening and the ease of post-treatment monitoring for recurrence. In the absence of large randomized trials, predictive models currently represent the most accurate means of anticipating the clinical course of this disease. We assess whether currently available models for biochemical recurrence after radical prostatectomy and external beam radiation therapy (EBRT) support the practice of a prolonged waiting period before transplantation.
METHODS: A MedLine search was conducted to identify predictive models published between 2000 and 2012, which examined biochemical recurrence (BCR) after prostatectomy and EBRT for low risk prostate cancer. Five predictive models were identified for prostatectomy, and five predictive models were identified for EBRT. The likelihood of BCR at two and five years after treatment was identified for each prostatectomy series (Table 1) and at five years for each EBRT series (Table 2).
RESULTS: Each of the five series demonstrated that the likelihood of BCR for low risk prostate cancer after prostatectomy was identical at two and five years and did not exceed 5% (mean 3.33%, SD 1.52). BCR at five years varied between 2% and 25% (mean 13.4%, SD 9.07) among predictive models analyzing EBRT.
CONCLUSIONS: The likelihood of BCR does not increase during the first five years after radical prostatectomy for low-risk prostate cancer. Additionally, the risk of recurrence approaches zero during this period. Therefore, current evidence does not support the mandated waiting period of five years between prostatectomy and transplantation. On the other hand, available predictive models for EBRT demonstrate significant variability of BCR at five years after treatment. The inclusion of older and less effective EBRT protocols likely account for greater variability. While EBRT represents an excellent treatment modality for localized prostate cancer, further study is necessary before it can be recommended to precede immediate transplantation.

Likelihood of biochemical recurrence (BCR) after radical prostatectomy for low-risk prostate cancer.

Series	Year	No. patients	Predictive Model	BCR at 2 years	BCR at 5 years
Han et al.	2003	2091	Probability tables	2%	3%
Stephenson et al.	2005	1881	Nomogram	1%	2%
Walz et al.	2008	2911	Nomogram	2%	5%
Kattan et al.	2009	7724	Nomogram	<5%	-
O'Brien et al.	2010	1939	Nomogram	2.5%	-

Likelihood of biochemical recurrence (BCR) after EBRT for low-risk prostate cancer.

Series	Year	No. patients	Prediction Model	BCR at 5 years
Kattan et al.	2000	1048	Nomogram	15%
D'Amico et al.	2002	381	Risk groups	18%
Kupelian et al.	2004	785	Probability graph	7%
Zelefsky et al.	2007	2253	Nomogram	25%
Yoshioka et al.	2009	436	Prob. graph	<2%