Are HIV-infected men vulnerable to prostate cancer treatment disparities? - Abstract

Background: HIV-infected (HIV+) men face cancer treatment disparities which impact outcome.

Prostate cancer (PCa) treatment and treatment appropriateness in HIV+ men are unknown.

Methods: We used electronic chart review to conduct a retrospective cohort study of 43 HIV+ cases with PCa and 86 age- and race-matched HIV-uninfected (HIV-) controls with PCa, aged 40-79, from 2001-2012. We defined treatment appropriateness using National Comprehensive Cancer Network (NCCN) guidelines and the Charlson Co-morbidity Index (CCI) to estimate life expectancy.

Results: Median age was 59.5 years at PCa diagnosis. Median CD4+ T-cell count was 459.5cells/mm3, 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy (RP) was the primary treatment for 39.5% of HIV+ and 71.0% of HIV- men (p= 0.004). Only 16.3% of HIV+ vs. 57.0% of HIV- men received open RP (p< 0.001). HIV+ men received more radiotherapy (25.6% vs. 16.3%, p= 0.13). HIV was negatively associated with open RP (OR= 0.03, p= 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV+ men received appropriate treatment (89.2% vs. 100%, p= 0.003), due to 4 overtreated HIV+ men. Excluding AIDS from the CCI still resulted in fewer HIV+ men receiving appropriate treatment (94.6% vs. 100%, p = 0.03).

Conclusion: PCa in HIV+ men is largely appropriately treated. Under-or overtreatment may occur from difficulties in life expectancy estimation. HIV+ men may receive more radiotherapy and fewer RPs, specifically open RPs.

Impact: Research on HIV/AIDS survival indices and etiologies and outcomes of this PCa treatment disparity in HIV+ men is needed.

Written by:
Murphy AB, Bhatia R, Martin IK, Klein DA, Hollowell CM, Nyame Y, Dielubanza E, Achenbach C, Kittles RA.   Are you the author?
Feinberg School of Medicine, Department of Urology, Northwestern University; Institute of Public Health and Medicine, Northwestern University; Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania; Feinberg School of Medicine, Northwestern University; Department of Surgery, Division of Urology, Cook County Health and Hospitals System; Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation; Department of Urology, Northwestern University; Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine; Institute of Human Genetics, University of Illinois at Chicago.   a-

Reference: Cancer Epidemiol Biomarkers Prev. 2014 Jul 25. pii: cebp.0614.2014.
doi: 10.1158/1055-9965.EPI-14-0614

PubMed Abstract
PMID: 25063519 Prostate Cancer Section