Alarmingly High Rate of Prostate Cancer Detected by Routine Prostate-Specific Antigen Screening in a County HIV Clinic

Abstract

Background Routine prostate-specific antigen (PSA) screening in the general population and in HIV-infected men is controversial. The aim of this study is to determine the prevalence of prostate cancer (PC) among patients living with HIV (PLWH).MethodsAfter an index case of PC was detected by sporadic PSA screening, we performed a prospective (2/2010–10/2016) cohort study following PSA levels and biopsies of African-American (AA) men ≥45 years and non-AA men ≥50 years. Screening was done at the discretion of the provider.ResultsOf the 124 men (82 AA, 17 Hispanic, 16 Caucasian, 7 Asian, 2 other) who received PSA screening, 7 (5.6%) had a PSA > 5 and underwent prostatic biopsy. Five patients (4%) were found to have PC, all of whom had a history of good long-term HIV virologic control. Mean age of PC patients was 60 years vs. non-PC patients (55 years) (P = 0.031). Mean years of HIV in PC patients was 18 years vs. non-PC patients (14 years) (P = 0.068).CaseAgeRacePSA Value (ng/mL)Stage/ Glisson ScoreRisk FactorsTreatment1 index case68AA133 + 3 = 6aTransplant recipientradiation258AA6.23 + 3 = 6aNoneProstatectomy pending364AA143 + 5 = 8a mets to nodesPaternal history PCRadical prostatectomy; hormone treatment458Caucasian7.64 + 3 = 7aNoneRadical prostatectomy560Caucasian9.93 + 3 = 6aNoneTransferred care aAll specimens positive for PC.ConclusionPSA screening is controversial and not universally recommended. Other retrospective studies of PLWH have shown equally high rates of PC. Compared with the general population (1/1,000 non-AA and 1.7/1,000 AA), men in our cohort had a 25 times higher rate (4%)of PC. All patients had aggressive tumors and required surgery, including one patient with metastasis to regional nodes. As expected, age was a significant risk factor for PC. We recommend implementing routine cohort PSA screening in PLWH.Disclosures All authors: No reported disclosures.