HIV and prostate cancer: a systematic review of the literature

Abstract

Malignancy occurs with increased frequency in the HIV-positive population. The true incidence of prostate cancer in this population is unknown. In the few cases that have been presented in the literature, prostate cancer in HIV-positive men appears to behave much like it does in HIV-negative men. Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. Approximately 800 000 men in the United States are HIV positive, and innovative therapies have dramatically improved survival. HIV disproportionately impacts ethnic groups with increased risk of prostate cancer and has been associated with increases in the incidence of certain malignancies. Despite the high prevalence of both diseases, there is relatively little literature about prostate cancer in HIV-positive patients. There is no consensus on how to screen or treat this patient population. We review the literature with regards to incidence, screening, treatment, and outcomes of this poorly characterized population. We briefly discuss the impact of highly active antiretroviral therapy and testosterone supplementation in the development of prostate cancer. A systematic review of the literature was conducted using MEDLINE key words 'HIV,' 'prostate,' 'prostate cancer' and 'AIDS.' Manual bibliographic review of cross-referenced items was also performed. A total of 176 unique abstracts and publications were reviewed; many authors provided data on the incidence of HIV and various malignancies including prostate cancer. Twelve unique publications providing detailed information on 60 patients with HIV and prostate cancer were identified. Prostate cancer is a common malignancy in HIV-positive men. With improved therapies for HIV and increasing survival, the importance for screening and treating prostate cancer is increasing. Acute outcomes of treatment do not demonstrate increased acute morbidity; however long-term outcomes have not been reported.

Robot-assisted laparoscopic radical prostatectomy in men with human immunodeficiency virus

“…This is consistent with most published data. 17 Although a definitive explanation for the youthfulness of HIV-positive PCa patients cannot be reached in this study, it is likely a result of sampling bias related to the relatively young HIV-positive population overall. 3 Additionally, older HIV-positive men may be screened less aggressively for PCa than age-matched HIV-negative men because of a perceived shorter life expectancy.…”

“…[19][20] Radical retropubic prostatectomy, 21 laparoscopic radical prostatectomy, 22 cryosurgery, 22 external beam radiation therapy, 23 brachytherapy 24 and active surveillance 22 have been reported for HIVpositive men with localized PCa and found to be generally safe and efficacious in the short term. 17 The oncological risk posed by PCa in the HIV-positive cohort did not differ significantly from the non-HIVpositive cohort, based on a variety of prognostic data including PSA value, clinical tumor stage, biopsy Gleason sum, D'Amico risk stratification and pathological tumor grade or stage. Some authors have suggested that PCa may be more aggressive in patients with HIV; although this study has a limited number of HIV-positive patients with high CD4 counts and low viral loads, it does not support these assertions.…”

Urologic complications of HIV and AIDS

“…With improved therapies for HIV and increasing survival, the importance of screening for and treating prostate cancer is increasing. 88 It has been recommended that the standard PSA assessment should be done in HIV-positive patients, without the need for adjustments. 89 Some clinicians advocate PSA screening of HIV-positive patients in their early forties because of the potential for prostate cancer to present in a disseminated manner with nonspecific features.…”

HIV-Associated Urogenital Malignancies

“…Overall, the treatment for prostate cancer in patients with HIV should not differ from treatment approaches in HIV-negative patients [39,54,55].…”