Introduction
Men with end stage renal disease (ESRD) may also be diagnosed with prostate cancer (PCa). Historically active prostate cancer has ruled out the possibility of being considered for a renal transplant. Patients with treated prostate cancer and undetectable PSA may be considered after appropriate waiting time post-treatment. Prostate cancer is now categorised into low, intermediate and high risk disease based on PSA and Gleason grade on prostate biopsy. 

Treatment options discussed with Low / intermediate PCa patients without ESRD are: active surveillance (AS), brachytherapy (BS) external beam radiotherapy (EBR) and radical prostatectomy (RP)

Objective
Demonstrate our experience of managing patients with ESRD being considered for renal transplant (or re-transplantation) and low / intermediate grade Pca.

Methods
A retrospective database of ESRD patients being considered for renal transplant and concomitant PCa was assessed for demographic details, PCa diagnosis and management. Also, ESRD management including Renal transplant (RTx).

Results
During the last 12 years, 15 ESRD patients have been diagnosed with PCa as part of assessment for the transplant waiting list (RTxWL). One patient was found to have asymptomatic metastatic disease with a presenting PSA of 120ng/ml. 6 were included in an AS protocol, 8 underwent robotic radical prostatectomy (RRP).
 
8 patients post-RRP, Mean PSA 12.6 at Diagnosis; Biopsy Gleason 3+ 3 in one case 3+4 in two cases and 4+3 in the remaining 5 cases; all have undetectable PSA after mean 46 months f/u; 2 received RTx both 6 years post RRP and both have stable good renal function; 2 patients are active on the RTxWL; 3 are awaiting activation on the RTxWL between 6-12 m post RRP and 1 is suspended for 3 years.
6 patients on the AS protocol, Mean PSA 6.7 at Diagnosis; Mean Follow up 81 months; Biopsy Gleason 3+3 in four cases an 3+4 in the remaining two; 2 active on RTxWL on AS. 4 transplanted on AS. One was transplanted after 26 months on AS; he died of Oesophagus carcinoma with 93 months PCa progression-free follow-up (last PSA was 0.6). The second patient has stable renal function after 41 months f/u and is due to have a new PSA, Prostatic MRI and template biopsy this year; the 3rd had KTx on AS, the Tx failed and is currently back on Haemodialysis and does not wish to have a second transplant; regarding PCa he continues on AS. The  4th patient had PCa progression after 2 year  AS; treated with Radiotherapy plus hormones, 5 years later he got a kidney transplant.

Conclusion
Even though our cohort is small, our experience suggests that ESRD patients should be offered as the standard treatment option for low / intermediate risk PCa based on individual PCa disease characteristics and RTx options including whether a living or deceased kidney donor is available. AS in appropriate ESRD patients may no longer be a contra-indication to RTx.

Is low / intermediate grade prostate cancer still a contraindication for renal transplant?