Clinical Presentation and Outcomes of Prostate Cancer in an Urban Cohort of Predominantly African American, Human Immunodeficiency Virus–infected Patients

Abstract

To determine the clinical presentation and outcomes of prostate cancer in human immunodeficiency virus (HIV)-infected men compared with HIV-uninfected men in an urban setting. A retrospective cohort study of prostate cancer stage at diagnosis and mortality comparing HIV-infected patients with HIV-uninfected patients from 2000 to 2011 was carried out. Clinical features, HIV history, cancer presentation, and outcomes were reviewed. Cox proportional hazards analysis was performed to estimate the association between HIV status and mortality. A total of 54 HIV-infected subjects were identified and reviewed, and 49 of them had complete data available; they were compared with 1496 HIV-uninfected subjects with prostate cancer. HIV-infected subjects were younger (median age, 60.7 vs 64 years) and had a higher proportion of African Americans (92% vs. 45%). An elevated prostate-specific antigen (PSA) level (76%) was the predominant indication for biopsy; 10 patients (27%) with an elevated PSA level had normal findings on digital rectal examination. Eighteen men (37%) presented with stage III and IV disease compared with 14% in the general population (P <.001). Eight patients (16%) died of prostate cancer. Subjects with HIV progressed to death at a significantly faster rate than those in the general population (adjusted hazard ratio, 2.02; 95% confidence interval, 1.14-3.58). HIV-infected patients in this cohort presented with more advanced stage disease compared with the general population even though the majority were detected by screening PSA. The overall mortality rate was higher for HIV-infected patients with prostate cancer after controlling for race, tumor stage at diagnosis, and age. Prostate cancer screening methods may need to be individualized for HIV-infected men.