Clinical Presentation and Outcomes of Prostate Cancer in an Urban Cohort of Predominantly African American, Human Immunodeficiency Virus–infected Patients

Abstract

Objective To determine the clinical presentation and outcomes of prostate cancer in HIV-infected men compared to HIV-uninfected men in an urban setting. Methods A retrospective cohort study of prostate cancer stage at diagnosis and mortality comparing HIV-infected patients to HIV-uninfected patients from 2000 to 2011 was carried out. Clinical features, HIV history, cancer presentation, and outcomes were reviewed. Cox proportional hazards analysis was performed to estimate the association between HIV status and mortality. Results A total of 54 HIV-infected subjects were identified and reviewed and 49 had complete data available; they were compared to 1,496 HIV-uninfected subjects with prostate cancer. HIV-infected subjects were younger (median age 60.7 years vs. 64), and had a higher proportion of African-Americans (92% vs. 45%). Elevated PSA (76%) was the predominant indication for biopsy; ten (27%) patients with an elevated PSA had normal findings on digital rectal exam. Eighteen (37%) presented with stage III/IV disease, compared to 14% in the general population (P<0.001). Eight patients (16%) died from prostate cancer. Subjects with HIV progressed to death at a significantly faster rate than those in the general population (adjusted hazard ratio 2.02, 95% CI 1.14–3.58). Conclusion HIV-infected patients in this cohort presented with more advanced stage disease compared to the general population even though the majority were detected by screening PSA. The overall mortality rate was higher for HIV-infected patients with prostate cancer after controlling for race, tumor stage at diagnosis, and age. Prostate cancer screening methods may need to be individualized for HIV-infected men.

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

“…Several studies have reported trends toward a younger age at prostate cancer diagnosis in HIV-infected compared to uninfected men (5, 19, 20). A recent study in the largest HIV cohort in North America found that while age at prostate cancer diagnosis was younger among HIV-infected subjects, the difference was not statistically significant (21); findings were inconclusive with respect to young-onset prostate cancer in groups by HIV status because age was examined in 10-year bins rather than comparing age of young-onset prostate cancer cases by HIV status.…”

“…American Cancer Society (ACS) guidelines suggest screening at age 40 for men with multiple first-degree relatives with prostate cancer, age 45 for African Americans and men with a single first-degree relative diagnosed with prostate cancer at age < 65, and age 50 for men at average risk. With exception of a study by Riedel et al (5), little is known about young-onset prostate cancer among HIV-infected men in the HAART era. Given the evolving epidemiology of prostate cancer risk in HIV-infected men on newer ART regimens, further study is needed to understand if subpopulations of people living with HIV or AIDS (PLWHA) may be at heightened risk at an earlier age.…”

“…African American men are also at higher risk for more aggressive tumors, and higher prostate cancer-related mortality. Management of prostate cancer risk and outcomes in African American men is influenced by racial disparities in health care access, surveillance, treatment, and survival (5, 6, 8, 26, 27). African American men are disproportionately represented among HIV-infected men, a population more vulnerable to health care disparities in comparison to uninfected men (5, 27, 28).…”

“…Management of prostate cancer risk and outcomes in African American men is influenced by racial disparities in health care access, surveillance, treatment, and survival (5, 6, 8, 26, 27). African American men are disproportionately represented among HIV-infected men, a population more vulnerable to health care disparities in comparison to uninfected men (5, 27, 28). A recent study in the HAART era found that HIV-infected men were largely appropriately treated in comparison to HIV-uninfected men, though under- or over-treatment sometimes occurred due to difficulty estimating life expectancy (27); disparities by HIV status remained for some treatment options such as radical prostatectomy, which was performed less frequently in those with HIV-infection.…”

“…Considering these disparities by race and HIV-infection status, together with evidence of increased prostate cancer mortality (3) and lower rates of PSA screening in some HIV-infected cohorts (12), a better understanding of prostate cancer risk in HIV-infected men is needed to optimize cancer surveillance and health outcomes overall, and among sexual and racial minority groups. A retrospective study of prostate cancer outcomes in a predominantly African American HIV-infected urban cohort cited a high prevalence of intravenous drug use (IDU) and hepatitis C virus (HCV) infection in the study cohort as confounding factors, since these factors often influence linkage to care, comorbidities, and survival (5). Prospective cohort studies controlling for these and other confounding factors will provide more accurate estimates of prostate cancer risk by age and race in HIV-infected men.…”