The potential for vulnerabilities to prostate cancer treatment disparities in HIV-infected men, "Beyond the Abstract," by Adam B. Murphy, et al.

BERKELEY, CA (UroToday.com) - The major finding of the study was that HIV+ men were treated according to nationally accepted prostate cancer treatment guidelines. It seems that the overtreatment stemmed from the difficulty in estimating life expectancy for HIV+ patients using life expectancy calculators that have not been updated for HIV status.

There were different treatments assigned to the HIV+ men relative to their HIV- counterparts. Radical prostatectomy (RP) was the primary treatment for 39.5% of HIV+ and 71.0% of HIV-men (p= 0.004); HIV+ men underwent radical prostatectomy significantly less. 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).

We are unsure of the source of this disparate treatment pattern. Radical prostatectomy was less common compared to the rates reported in the general population in our national cohort data (data not yet published). More research should be done to investigate the patient and provider factors in prostate cancer treatment selection for HIV+ patients. One patient concern is that the HIV+ men could be less willing to deal with treatment side effects of radical prostatectomy. Surgeons may be concerned about the risk of HIV exposure to the operative team during a radical prostatectomy. The risk of HIV transmission is extremely low, lower than Hepatitis C with the use of universal precautions and could be assessed by measuring a patient’s viral load. Risk is even lower in this era of robotic radical prostatectomy. Urologists performing radical prostatectomies may be concerned about post-operative complications. Studies on prostate cancer treatment outcomes are limited, but all point to safety in men with CD4+ cell counts > 400cells/mm3 and low to undetectable viral RNA copies.

Treatment recommendations are based on life expectancy estimation, which remains a challenge in this population. At the present time, the recommendation from the American College of Surgeons is to treat patients who are stable on highly active antiretroviral therapy as they would the general population.

Written by:
Adam B. Murphy,1 Ramona Bhatia,2 Iman K. Martin,3 David A. Klein,4 Courtney M.P. Hollowell,5 Yaw Nyame,6 Elodi Dielubanza,1 Chad Achenbach,7 and Rick A. Kittles8 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

1Department of Urology, Northwestern University, Chicago, IL USA
2Institute for Public Health and Medicine, Northwestern University, Chicago, IL USA
3Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA USA
4Feinberg School of Medicine, Northwestern University, Chicago, IL USA
5Division of Urology, Department of Surgery, Cook County Health and Hospitals System, Chicago, IL USA
6Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH USA
7Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL USA
8Institute of Human Genetics, University of Illinois at Chicago, Chicago, IL USA

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

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