HIV and prostate cancer

Highly active antiretroviral therapy (HAART) for the treatment of HIV-positive patients has delayed progression of HIV to AIDS and promoted immune system restoration thereby reducing AIDS-related mortality. Non-AIDS-defining malignancies such as prostate cancer (PCa) have been diagnosed more frequently given such extended survival. However, the actual incidence of prostate cancer in the HIV population remains ambiguous. This chapter includes search of all English-language articles describing HIV and prostate cancer between 1975 and 2011. A total of 1,178 patients with HIV and PCa were identified from the literature (87 patients from case reports, 1,091 from population-based studies). Prostate cancer incidence in HIV patients is different than the general population in multiple studies, and in the largest and most recent PSA-era population studies, incidence is typically decreased compared with the general population. During the HAART era, differences in PSA kinetics and prostate cancer behavior between HIV-positive and HIV-negative patients have not been apparent. HIV-infected patients should be managed in accordance with the most recent American Urological Association (AUA) guidelines which recommend screening of all men with age ≥40 years and a life expectancy of >10 years. All treatment options offered to the general population with prostate cancer should be available to the HIV-positive population with prostate cancer. Although long-term outcomes are still being accrued, initial results indicate response rates which are similar to HIV-negative patients.