HIV and Prostate Cancer: A Systematic Review of the Literature
HIV and Prostate Cancer: A Systematic Review of the Literature
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.
Tumor registries have demonstrated that HIV is associated with an increased incidence of certain malignancies such as Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer. These so-called AIDS-defining malignancies make up approximately two-thirds of all cancers among people with AIDS. In addition, several genitourinary malignancies have been demonstrated to have an increased incidence in the HIV-positive population including seminoma and possibly renal cell carcinoma. Interestingly, some malignancies such as breast cancer have been shown to occur at a reduced rate in this population.
According to the Centers of Disease Control, at the end of 2003 an estimated 1 039 000-1 185 000 persons in the United States were living with HIV/AIDS and about three quarters of these patients were men. More than half of all newly diagnosed HIV patients are African American and more then a quarter are over the age of 45. With the advent of highly active antiretroviral therapy (HAART), the overall progression of HIV infection to AIDS and from AIDS to death has slowed, and survival has increased dramatically.
Prostate cancer (PCa) is the most common malignancy in men. Its incidence increases as men age and it is more prevalent in African Americans. Men with HIV represent a unique cohort of patients to whom urologists must be able to offer appropriate information regarding incidence, screening, treatment and outcomes with respect to PCa.
Though there are several epidemiologic studies that estimate the incidence of PCa in HIV-positive men, there is a paucity of data that examine specific characteristics of this patient population. To this end, we performed a systematic review of all studies on HIV-positive men who were diagnosed with PCa. Twelve studies included data on 60 unique patients diagnosed with PCa and HIV ( Table 1 ). The age range (average) at the time of diagnosis was 40-79 years (57.8). Most men were identified because of an elevated prostate-specific antigen (PSA; 52%) and had no palpable tumor on digital rectal examination (DRE; T1c 27/52 patients); 18 patients were determined to have localized palpable tumors (35%), 3 patients (5.8%) had locally advanced PCa and 4 patients (7.7%) had metastatic disease at the time of diagnosis. The average number of years with HIV before diagnosis was 8.8 years (6 months-20 years), the average viral load at the time of diagnosis was 10 006 copies per ml (undetectable set at 25 copies per ml to > 100 000 copies), and average CD4 count was 425.2 cells per µl (24-1070). The average Gleason score was 6.57 (5-8).
Herein, we present a summation of the current literature regarding HIV and PCa in an attempt to better characterize the disease in this population.
Abstract and Introduction
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.
Introduction
Tumor registries have demonstrated that HIV is associated with an increased incidence of certain malignancies such as Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer. These so-called AIDS-defining malignancies make up approximately two-thirds of all cancers among people with AIDS. In addition, several genitourinary malignancies have been demonstrated to have an increased incidence in the HIV-positive population including seminoma and possibly renal cell carcinoma. Interestingly, some malignancies such as breast cancer have been shown to occur at a reduced rate in this population.
According to the Centers of Disease Control, at the end of 2003 an estimated 1 039 000-1 185 000 persons in the United States were living with HIV/AIDS and about three quarters of these patients were men. More than half of all newly diagnosed HIV patients are African American and more then a quarter are over the age of 45. With the advent of highly active antiretroviral therapy (HAART), the overall progression of HIV infection to AIDS and from AIDS to death has slowed, and survival has increased dramatically.
Prostate cancer (PCa) is the most common malignancy in men. Its incidence increases as men age and it is more prevalent in African Americans. Men with HIV represent a unique cohort of patients to whom urologists must be able to offer appropriate information regarding incidence, screening, treatment and outcomes with respect to PCa.
Though there are several epidemiologic studies that estimate the incidence of PCa in HIV-positive men, there is a paucity of data that examine specific characteristics of this patient population. To this end, we performed a systematic review of all studies on HIV-positive men who were diagnosed with PCa. Twelve studies included data on 60 unique patients diagnosed with PCa and HIV ( Table 1 ). The age range (average) at the time of diagnosis was 40-79 years (57.8). Most men were identified because of an elevated prostate-specific antigen (PSA; 52%) and had no palpable tumor on digital rectal examination (DRE; T1c 27/52 patients); 18 patients were determined to have localized palpable tumors (35%), 3 patients (5.8%) had locally advanced PCa and 4 patients (7.7%) had metastatic disease at the time of diagnosis. The average number of years with HIV before diagnosis was 8.8 years (6 months-20 years), the average viral load at the time of diagnosis was 10 006 copies per ml (undetectable set at 25 copies per ml to > 100 000 copies), and average CD4 count was 425.2 cells per µl (24-1070). The average Gleason score was 6.57 (5-8).
Herein, we present a summation of the current literature regarding HIV and PCa in an attempt to better characterize the disease in this population.