[Evaluation of serum PSA in brain-dead subjects over the age of 50 before organ harvesting: organ donation and the risk of transmission of prostate cancer. Survey of the transplantation committee of the Association Francaise d'Urologie]

Cancer in a brain-dead subject constitutes a contraindication to organ harvesting. However no data are available on prostatic assessment of brain-dead subjects prior to organ harvesting. The objective of this study was to evaluate prostate cancer screening by serum PSA assay in potential organ donors over the age of 50. METHODS: From February to May 2006, serum PSA assays were performed in all male donors in 5 different organ harvesting centres. The donor's age and the duration of bladder catheterization were also recorded. RESULTS: Of the 85 organ harvests performed, 30 (35.3%) concerned men over the age of 50 years (mean: 60.4 years, range: 50-82 years). The mean duration of catheterization was 3.1 days (range: 0.5-22 days). The mean PSA level was 8.7 ng/ml (range: 0.03-52.7) with a free PSA/total PSA ratio of 31% (range: 14-47). Twelve donors had a PSA level greater than 4 ng/ml (4.7 to 52 ng/ml), two others had a PSA level greater than 2.5 ng/ml (2.77 and 3.3 in subjects aged 72 and 57 years, respectively). There was no correlation between the donor's age, their PSA level and the duration of catheterization. CONCLUSION: The age of brain-dead donors is increasing and is reaching the age limit recommended by the Association Francaise d'Urologie for prostate cancer screening by digital rectal examination and PSA assay. Although the risk of transmission of prostate cancer after transplantation is currently unknown, at this stage when the majority of prostate cancers are discovered in a context of elevated PSA with normal digital rectal examination, the risk of transmission of a prostate cancer from the donor to the recipient is minimal or even non-existent. Digital rectal examination findings may be more relevant than PSA to contraindicate organ harvesting.