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Management of prostate cancer in HIV-positive patients

Nature Reviews Urology volume 7, pages 348–357 (2010)Cite this article

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Abstract

Improved medical therapy for HIV-positive patients has helped delay the progression of HIV to AIDS and reduce AIDS deaths. This dramatically prolonged survival has resulted in increased detection of non-AIDS-defining malignancies, such as prostate cancer, in people with HIV. Reported prostate cancer incidences in HIV-positive men compared with the general population vary in different studies; however, its incidence in the general population has generally increased over time, owing to the widespread use of PSA testing and increased life expectancy. In the highly active antiretroviral therapy (HAART) era, evidence indicates that PSA kinetics and prostate cancer behavior are similar in HIV-positive and HIV-negative patients. Current American Urological Association (AUA) guidelines recommend screening of all men aged ≥40 years with a life expectancy >10 years, and HIV-positive patients should be included in this recommendation. Treatment options for HIV-positive patients with prostate cancer should include all those offered to the general population. Long-term treatment outcomes in HIV-positive patients remain uncertain; however, early results suggest response rates similar to those in HIV-negative patients.

Key Points

  • With the prolonged survival of HIV-positive patients receiving highly active antiretroviral therapy, the screening, diagnosis and treatment of non-AIDS-defining malignancies, such as prostate cancer, now need to be addressed

  • All HIV-positive males aged 40 years or over with a 10-year life expectancy should be screened for prostate cancer, in accordance with current recommendations for the general population

  • HIV-positive patients with localized prostate cancer should be offered all available treatment options

  • Clinical stage and grade of prostate cancer, as well as HIV status and treatment history, are important considerations in determining the appropriate cancer therapy

  • Early results indicate that responses to prostate cancer therapies in HIV-positive patients are comparable to those of the general population

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Authors and Affiliations

  1. Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, 10032, NY, USA

    Matthew S. Wosnitzer

  2. Department of Urology, St. Luke's/Roosevelt Hospital, 425 W. 59th Street, 3A, New York, 10019, NY, USA

    Franklin C. Lowe

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  1. Matthew S. Wosnitzer
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  2. Franklin C. Lowe
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Correspondence to Franklin C. Lowe.

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Wosnitzer, M., Lowe, F. Management of prostate cancer in HIV-positive patients. Nat Rev Urol 7, 348–357 (2010). https://doi.org/10.1038/nrurol.2010.61

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