Prostate Cancer Outcomes in Immunocompromised Patients: A Systematic Review and Meta-analysis.

Background and objective: The role of immunosuppression in prostate cancer (PCa) mortality is a debated topic, with a low level of evidence. This review aims to evaluate the cancer-specific mortality (CSM) and overall mortality (OM) of PCa in immunocompromised patients compared with immunocompetent individuals.

Methods: A literature search was conducted in the PubMed/Medline, Embase, and Web of Science databases (up to the March 31, 2024). The analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42022361504). Data were pooled using a fixed-effect model and adjusted hazard ratios (HRs).

Key findings and limitations: A total of 13 studies (n ≈ 3.4 million PCa patients) were included in the qualitative analysis; 11 studies were included in the quantitative analysis. The forest plot for CSM in immunocompromised patients failed to reach statistical significance (HR 1.04 [95% confidence interval {CI}, 0.91-1.18], p = 0.57). OM was higher in the immunocompromised cohort (HR 2.04 [95% CI, 1.94-2.15], p < 0.001). CSM for transplanted patients was comparable with that for the controls (HR 1.01 [95% CI, 0.86-1.18], p = 0.94). Patients with human immunodeficiency virus (HIV) had higher CSM rates (HR 1.83 [95% CI, 1.21-2.75], p = 0.004). Limitations included retrospective cohort studies and heterogeneity in reporting PCa stages.

Conclusions and clinical implications: Transplanted patients present a CSM rate comparable with the controls, despite a higher OM rate. Other immunocompromised patients present an overall worse prognosis. The treatment algorithm should be applied by international guidelines for transplanted patients, delivering more aggressive treatments and screening strategies.