SUO 2017: Prostate Cancer Presentation, Treatment Selection, And Outcomes Among Men With HIV/AIDS: A Contemporary Clinical Stage And Age-matched Analysis

Washington, DC (UroToday.com) Introduction: The clinical presentation, oncologic outcomes and optimal management of prostate cancer (PC) among human immunodeficiency virus-seropositive (HIV+) men is nod described well enough. The objectives of the authors was to compare the clinical characteristics, treatment decisions, and oncologic outcomes in a contemporary series of matched HIV+ and HIV negative (HIV-) men with PC.

Methods: For the purpose of this study, the charts of 3135 men treated for PC from 2000 to 2016 were reviewed. HIV+ patients (N=46) were matched 1:2-3 by age and clinical stage to HIV-negative controls (N=137). Clinicopathologic features, primary treatment, and oncologic outcomes were compared with Kaplan Meier and Cox proportional hazards analyses.

Results: HIV- and HIV+ patients were similar with respect to median age (58.2 vs. 57.2 years, p=0.2), initial PSA (10.6 vs. 10.5 ng/mL), clinical stage (cT1/2: 94% vs. 88%,cN1: 8% vs. 6.5%, cM1: 10.9% vs. 10.9%, p=0.4), and ECOG performance status. Among HIV+ men, 67.4% had a history of AIDS, and 91.3% were on HAART at PC diagnosis, with median viral load and CD4+ count of 40 copies/mL and 400 cells/mm3. Median time from HIV diagnosis to PC diagnosis was 8.6 years. Among men with localized disease (N=153), HIV+ men (N=37) were more likely to receive radiation therapy (59.5% vs. 44.8%) or no therapy at all (13.5% vs. 4.3%) and less likely to receive surgery (16.2% vs. 30.2%), or initiate active surveillance (10.8% vs. 16.4%; p=0.04 overall) than HIV-. There were no associations with HIV status with respect to rates of biochemical recurrence (Hazard ratio [HR] 0.79; p=0.6), clinical progression (HR 0.89,
p=0.8), castration resistance (HR 0.71, p=0.1), or PC-death (HR 3, p=0.1). However, HIV+ status was associated with an increased risk of all-cause death (HR 2.89, p=0.04) with median follow-up of 4.2 years (range 0-14).

Conclusion: HIV+ men with localized PC were significantly less likely to receive surgery and definitive treatment overall than HIV- controls. While most HIV+ patients had a history of AIDS, HIV was well controlled in the majority of patients at the time of PC diagnosis. Oncologic outcomes were similar between stage- and age-matched HIV+ and HIV- men. This study represents the largest contemporary cohort of HIV-seropositive men with PC to be described to date.

Presented by: Sarah P. Psutka, Northwestern University, Chicago, IL

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC
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