Management of prostate cancer in HIV-positive patients

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.