Prostate cancer in men with HIV
As people with HIV are living longer thanks to treatment (antiretroviral therapy; ART), they become at risk for issues related to aging.
Rates of prostate cancer in the U.S. are relatively high among men without HIV. Researchers at George Washington University in Washington, DC, reviewed medical records from their university’s cancer clinic. The researchers focused on cases of prostate cancer in men with HIV. They limited their review to cancers that were restricted to the prostate (in other words, the cancer had not spread from the prostate to other organs).
Their review, which encompassed the period from 2007 to 2020, found records of 79 patients with HIV who were diagnosed with prostate cancer.
The average profile of HIV-positive participants at the time they were diagnosed with prostate cancer was as follows:
- age – 61 years (ranging from 49 to 79 years)
- main ethno-racial groups: Black – 82%; White – 18%
- 34% had a close male relative with prostate cancer
- cancer grade: 17% had low-grade cancer; 44% had medium-grade cancer; 33% had high-grade cancer
- 92% were taking ART and 53% had an undetectable viral load
- CD4+ count – 436 cells/mm3
Participants were monitored for up to five years.
Prostate cancer treatment
Common approaches to prostate cancer treatment included removal of the prostate followed by the use of drugs that reduced production of testosterone. The use of such drugs is sometimes necessary, as prostate cancer is sensitive to testosterone and depriving this cancer of testosterone helps to inhibit its growth. Patients with low-grade prostate cancer were frequently monitored and surgery and/or other treatment was offered if the cancer became more aggressive. Participants who had high-grade prostate cancer were treated with either radiation therapy and drugs that reduced testosterone production or removal of the prostate followed by radiation therapy to kill any residual cancer cells.
Results
Overall, 98% of participants were alive five years after their diagnosis of prostate cancer. No one died from complications related to prostate cancer. One man died 11 years after his prostate cancer diagnosis from a severe bacterial infection arising from an inflamed intestine.
CD4+ cell count changes
Some research centres reported a temporary decrease in CD4+ cell counts, particularly after radiation therapy for prostate cancer. For many patients with HIV, a lower CD4+ count can be psychologically distressing. However, the decreases in CD4+ cells were usually temporary and there were no reports of increased risk of infections arising because of this.
In the present study, there was a trend to lowered CD4+ counts, usually a decrease of 150 cells/mm3. However, medical records were incomplete and not everyone’s CD4+ count was available for analysis. Also, CD4+ counts were not available to the researchers after prostate cancer therapy cessation, so they could not be certain how long the decrease in CD4+ cells lasted.
Effect of HIV
As HIV weakens the immune system, there is always concern that cancers may be more aggressive or less responsive to therapy in people with HIV. However, researchers found that HIV did not appear to cause a more aggressive course of prostate cancer. Certainly, the death rate in the men with HIV in the study was very low and no one died from prostate cancer. Ideally, the researchers should have had a group of HIV-negative men of the same age with prostate cancer for purposes of comparison.
For the future
The present study is small and looked back upon data captured in the past; such studies are not suited to provide definitive results. However, hopefully the study will encourage other researchers to design prospective clinical trials to better understand prostate cancer in a larger number of men with HIV.
—Sean R. Hosein
Resource
REFERENCE:
Vaziri T, Rao YJ, Whalen M, et al. Management of localized prostate cancer in men with human immunodeficiency virus: Analysis of a large retrospective cohort. Clinical Genitourinary Cancer. 2023 Oct;21(5):614.e1-614.e8.