HIV-associated prostate cancer

Abstract

16089 Background: HIVpositive men being treated with highly active antiretroviral therapy (HAART) are living longer. As a result, these ageing patients are more likely to develop non-AIDS defining cancers such as prostate cancer. The aim of this study was to characterize HIV-infected patients diagnosed and treated for prostate carcinoma. Methods: A retrospective, multi-institutional study involving HIV positive men with concomitant prostate carcinoma. We caputred data on demographics, HIV status, PSA level, symptoms/signs, radiologic findings, Gleason score, stage, cancer treatment, and outcome (response, survival). Data was analyzed using descriptive statistics. Results: 17 patients (8 White, 3 Black, 2 Hispanic, 1 Haitian, 2 unknown race) with HIV-associated prostate carcinoma that were of mean age 59 years (range, 46 to 79). Mean CD4 count was 336 cells/mm3 (range 24 to 759) and mean HIV viral load 17,319 copies/ml (range, undetectable to >100,000). 14 (82%) of these men were receiving HAART. Most patients were diagnosed with carcinoma following an abnormal screening PSA. Mean PSA in this group was 30 ng/mL (range, 4.5 to 77; median 20). Only 6 (35%) men had an abnormal prostate on exam. The mean Gleason score was 6.8 (range 6 to 8), and in most cases cancer was confined to the prostate gland (stage T1 in 64%; 1 case had bone metastases). Most patients were amenable to curative treatment with either hormonal therapy (used alone in 2 cases), radiation (brachytherapy only in 3 cases), and/or prostatectomy (resection alone in 3 cases). Besides hot flushes in 4 men after hormonal therapy, there were no serious side effects. One patient remained untreated. All treated patients had a complete response (undetectable PSA). Most patients were long term survivors. Documented death in 5 cases was unrelated to prostate cancer. Conclusion: Management of HIV-positive men with prostate carcinoma in is becoming increasingly important. Our data shows that in men receiving HAART, their age, PSA levels, clinical presentation, management, and outcome from treated prostate carcinoma does not appear to be significantly altered by HIV status. Therefore, we recommend that patients with prostate cancer and well controlled HIV viremia be managed like their HIV negative counterparts. Further research related to screening for prostate cancer in this setting is required. No significant financial relationships to disclose.