Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study

Abstract

Purpose African American men have the highest incidence of prostate cancer among ethnic groups, and racial disparity is highest in younger men. Prostate cancer prevalence is rising in HIV-infected men due to improved survival on antiretroviral therapies, yet little is known about racial differences in prostate cancer risk by HIV-infection status and age. Methods Prospective cohort study of prostate cancer risk in 2800 HIV-infected and -uninfected men who have sex with men (MSM) ages 40–70 (22% African American) in the Multicenter AIDS Cohort Study from 1996–2010. Poisson regression models were used to examine associations between race or HIV-infection status and prostate cancer risk among men ages 40–70, 40–55, and 56–70. Results Among men ages 40–70, incidence rates (IR) per 100,000 person years were 169 among all men and 276 among African American HIV-infected men. Prostate cancer risk was similar by HIV-infection status (IRR 1.0, 95% CI 0.55–1.82), but nearly 3-fold higher in African Americans compared to non-African Americans in adjusted models (IRRs 2.66 and 3.22, 95% CIs 1.36–5.18 and 1.27–8.16 for all or HIV-infected men, respectively). Racial disparity in prostate cancer risk was greatest in African American men ages 40–55 (adjusted IRR 3.31, 95% CI 1.19–9.22). Prostate cancer risk showed associations with family history of prostate cancer (p =0.001), but not heavy smoking, androgen supplement use, or HIV-related factors. Conclusions Among MSM, African American HIV-positive and HIV-negative men ages 40–55 have nearly a 3-fold increased risk of young-onset prostate cancer compared to non-African American men, highlighting the need to make informed decisions about screening in this population.

Prostate Cancer Diagnosis Rates among Insured Men with and without HIV in South Africa: A Cohort Study

“…In line with previous US-based studies ( 5 , 6 , 20 ), we found lower crude prostate cancer diagnosis rates among MWH than men without HIV. However, we observed no clear overall effect of HIV on prostate cancer diagnosis rates after adjusting for potential confounders.…”

Prostate Cancer Screening and Incidence among Aging Persons Living with HIV

“…18 To date, no studies with sufficient sample size, age representation, or longitudinal followup have defined screening practices among PWH and the potential effects on cancer incidence or other factors that may limit detection. 3,5,11,12,19 As a growing number of PWH enter their fifth and sixth decades of life, opportunities for prostate cancer detection are likely to increase. Therefore, we aimed to characterize PSA screening practices among PWH and estimate standardized prostate cancer risk by HIV status while accounting for PSA testing.…”

“…Reduced opportunities for detection contributed by HIV infection should contextualize prior studies which have routinely identified lower incidence rates of prostate cancer among PWH. 3,5,11,12,19,27 Only 1 previous study, comprised predominately of younger patients, accounted for the effects of PSA testing. In that study, which included 74 incident prostate cancers, the adjusted incidence of prostate cancer remained lower for PWH.…”