Prostate Cancer in Men with Treated Advanced Heart Failure: Should we keep Screening?

Objectives To evaluate the outcomes of men diagnosed with prostate cancer (PCa) following implanted treatments for advanced heart failure. Given the increasingly favorable 10-year life expectancy, MedStar Washington Hospital Center (MWHC) screens heart transplant (HT) candidates for PCa and other malignancies prior to intervention. Methods Men aged 18-90 with normal pre-transplant PSA who underwent LVAD/HT at MWHC from 2007-2018 were identified. Serum PSA, PCa diagnosis, and treatment were captured and analyzed. Survival was analyzed using Kaplan-Meier curves. Results Data was available for 34 patients. Median age was 53 [IQR=51-58]. Median follow-up was 77mo (95% CI=40-87mo). Six men had post-implant elevated PSA (5.3; SD=8.5) and 4 were diagnosed with PCa. Median age of PCa diagnosis was 59 [IQR=58.5-62). As of 2018, 31 of the 34 patients were living, and none died from PCa. Five-year survival was 96% in those without PCa and 100% in those with PCa (figure 2). Conclusion Our cohort represents the largest known cohort with heart failure treated by LVAD/HT and PCa. Our median age of 59 at PCa diagnosis is considerably younger than the national median of 66. 1 Of the 4 individuals diagnosed with PCa, 3 had high grade disease. Given the favorable long-term survival of these patients post-LVAD/HT, age-appropriate treatment for PCa should be continued post-implantation.