HIV and Prostate Cancer: A Systematic Review of the Literature

UroToday (www.UroToday.com) contributing editor, Christopher P. Evans, MD, reports that in the online edition of Prostate Cancer Prostatic Diseases, Dr. Jonathan Silberstein and his colleagues presented a systematic review of HIV and prostate cancer (CaP). The message that may be underappreciated by the urology community is the excellent longevity of HIV patients, which clearly impacts their potential for diagnosis and management of CaP.

In 2003, over one million people were living with HIV in the US and three quarters of them were men. Furthermore, more than half of the newly diagnosed men with HIV were African American, thus having a greater risk for CaP. The use of antiretroviral therapy has resulted in the life-expectancy of a 25-year-old newly diagnosed with HIV to be 39 years. From the time an individual enters HIV care, the per-person projected life expectancy is 24.2 years. A total of 37,000 new cases of HIV were reported in the US in 2006.

In this systematic review, 12 studies were identified that included data on men with HIV and CaP. The average age was 57.8 years at the time of diagnosis. Most men had an elevated PSA and a normal DRE. The average number of years with HIV prior to the CaP diagnosis was 8.8, the average viral load at diagnosis was 10,006 copies per ml, and the average CD4 count was 425.2 cells per microliter. The average Gleason score was 6.57.

Series CaP reporting treatment of HIV positive men included radical prostatectomy, radiotherapy and brachytherapy. The limited surgical series did not suggest worse outcomes with regard to complications, quality of life, or cancer. Likewise, CaP radiotherapy seemed well tolerated and better than radiotherapy for HIV patients with rectal cancer. One case report of an HIV-positive man who underwent brachytherapy discussed the development of a prostatic abscess. The underlying cancer ultimately was squamous cell carcinoma of the prostate and rectum. Another mixed radiotherapy and brachytherapy series did not suggest differences in outcomes between HIV-positive and HIV-negative men with CaP. The prevalence rate for hypogonadism was 20% higher in HIV-positive patients, and a PSA test and biopsy should be considered prior to testosterone replacement.

Silberstein J, Downs T, Lakin C, Kane CJ

Prostate Cancer Prostatic Dis. 2008 Aug 19. (Epub ahead of print)
10.1038/pcan.2008.44