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Wiley InterScience

BJU International

Volume 101 Issue 12, Pages 1519 - 1523

Published Online: 2 Apr 2008

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Human immunodeficiency virus-associated prostate cancer: clinicopathological findings and outcome in a multi-institutional study

Liron Pantanowitz, Gerry Bohac*, Timothy P. Cooley†, David Aboulafia‡ and Bruce J. Dezube§

Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, †Department of Medical Oncology, Lahey Clinic, Burlington, §Department of Medicine (Hematology-Oncology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, *Department of Medicine, Rush University, Chicago, IL, and ‡Department of Medicine (Hematology and Oncology), Virginia Mason Medical Center, Department of Medicine, University of Washington, Seattle, WA, USA

Correspondence to Liron Pantanowitz, Department of Pathology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
e-mail: Liron.pantanowitz@bhs.org

KEYWORDS

AIDS • cancer • HAART • HIV • prostate

ABSTRACT

To characterize the clinicopathological findings and the outcome of human immunodeficiency virus (HIV)-infected patients diagnosed and treated for prostate carcinoma, as HIV-positive men being treated with highly active antiretroviral therapy (HAART) are living longer and thus are more likely to develop cancers such as prostate cancer.

PATIENTS AND METHODS

We performed a retrospective, multi-institutional study involving HIV-positive men with concomitant prostate carcinoma. We collected data regarding patient demographics (age, race), HIV status (CD4⁺ cell count, HIV viral load, HAART), PSA level (at cancer diagnosis), symptoms and signs, radiological findings, pathology (Gleason score, stage), cancer treatment (type, side-effects), and outcome (response, survival). Accrued data was analysed using descriptive statistics.

RESULTS

We identified 17 patients (mean age 59 years) with HIV-associated prostate adenocarcinoma. The mean CD4⁺ count was 336 cells/mm³ and the mean HIV viral load was 17 319 copies/mL. In all, 14 (82%) of these men were receiving HAART. Most patients were diagnosed with carcinoma after an abnormal screening PSA level. The mean PSA level was 30 ng/mL. Only six (35%) men had an abnormal prostate on examination. The mean Gleason score was 6.8, and in most cases, cancer was confined to the prostate gland. Most patients were amenable to curative treatment with hormonal therapy, radiation, and/or prostatectomy. There were no serious treatment related side-effects. One patient remained untreated. All treated patients had a complete response (undetectable PSA level). Most patients were long-term survivors. Documented death in five cases was unrelated to prostate cancer.

CONCLUSION

The management of HIV-positive men with prostate carcinoma in the HAART era 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 viraemia be managed similarly to their HIV-negative counterparts.

Accepted for publication 15 November 2007

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1464-410X.2008.07474.x About DOI