How do you approach treatment for high-risk prostate cancer in patients who need clearance for organ transplant listing?

Our initial approach for these patients is to engage their transplant physician to understand the barrier for organ transplant listing. For some patients, the presence of a detectable PSA is the rate limiting factor, while for others having untreated disease is the main issue. The difference between the two is that for the first case, androgen deprivation therapy will suppress PSA in the shortest interval and allow for listing. However, in the second case, generally surgical resection will result in the shortest interval to treatment and thus listing.

I think though that this philosophy may change as we move towards hypofractionated approaches, SBRT, and more brachytherapy in the high risk setting as these techniques result in much more dra...