Prostate cancer

Introduction

Prostate cancer is the most common malignancy in U.S. men. There are no significant differences in the clinical characteristics of prostate cancer in HIV infected men and the general population1. The deficit in prostate cancer observed among HIV-infected men is largely an artifact due to differential prostatespecific antigen (PSA) screening practices and is likely not due to a protective effect of HIV against the development of prostate cancer2. It is not related to hormone deficiency3.

 

Screening and Prevention

The PSA test and DRE (digital rectal examination) are primary screening tools in the early detection of prostate cancer. Transrectal ultrasound (TRUS) and TRUS-guided needle biopsies are performed to confirm diagnosis following primary screening. Thirteen-year follow-up data from the US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial showed no mortality benefit for organized annual screening with PSA and DRE1. The European Randomized Study of Screening for Prostate Cancer trial (ERSPC) reported a 20% reduction of prostate cancer-specific mortality in a prespecified subgroup of men aged 55–69 years but was associated with a high risk of overdiagnosis4, 5. In a combined meta-analysis of five RCTs, including the PLCO and ERSPC trials, data showed that prostate cancer screening did not significantly decrease prostate cancer-specific mortality and overall mortality1.

The American Urological Association recommends PSA screening and DRE be offered to asymptomatic men aged 40 years who wish to be screened, if estimated life expectancy is more than 10 years. Available data do not support unique screening processes in HIV-positive men1. EACS Guidelines 2013 recommend DRE ± PSA every 1-3 years in HIV men aged 50 years (with controversial use of PSA)6.

 

References

  1. Mania D. and Aboulafia DM. Screening guidelines for non-AIDS defining cancers in HIV-infected individuals. Curr Opin Oncol. 2013 Sep;25(5):518-525.
  2. Shiels MS, Goedert JJ, Moore RD, et al. Reduced risk of prostate cancer in U.S. men with AIDS. Cancer Epidemiol Biomarkers Prev 2010; 19:2910–2915.
  3. Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA 2001; 285: 1736-1745.
  4. Schroder FH, Hugosson J, Roobol MJ, et al., for the ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360:1320–1328.
  5. Heijnsdijk EA, Wever EM, Auvinen A, et al. Quality-of-life effects of prostatespecific antigen screening. N Engl J Med 2012; 367:595–605.
  6. European AIDS Clinical Society (EACS) Guidelines. Version 7.0. October 2013.