Are there treatment disparities in prostate cancer in HIV-infected men?

Background: Most HIV-infected (HIV+) persons will soon be over age 50 and vulnerable to prostate cancer (PCa). HIV+ patients are at risk for cancer undertreatment. We compared PCa treatments received in HIV+ and HIV-uninfected (HIV-) men. Methods: We developed a retrospective cohort of 43 HIV+ and 86 matched HIV- PCa patients seen at an academic hospital. We compared rates of appropriate treatment based on National Comprehensive Cancer Network (NCCN) guidelines and radical prostatectomy (RP). Results: The median age was 59 years and follow-up time was 7.5 years. Overall, 58% were Caucasian and 29% Black. Among cases, median CD4 cell count (CD4) was 367 cells/mm3, 98% received antiretroviral therapy, and 90% were virally suppressed. Median prostate specific antigen levels were similar between groups (p = 0.47). Overall, 56.8% of HIV+ and 46.5% of HIV- men (p = 0.30) had NCCN-defined low-risk PCa. No undertreatment occurred; however 3 HIV+ cases were overtreated based on life expectancy. RP utilization was lower in cases, and this persisted in cases with high calculated life expectancy (38.6% vs. 70.9%, p < 0.001). HIV+ status positively associated with receiving RP when adjusting for age, Charlson co-morbidity index score, body mass index, race, CD4, and viral suppression (OR = 0.31, CI: 0.13-0.74). All-cause mortality was non-significantly higher in cases (11.9 vs. 7.4/1000 person-years, p = 0.47). Conclusion: HIV is not associated with PCa undertreatment, but is associated with lower RP utilization among men with adequate life expectancy. Studies on etiologies and outcomes of this treatment disparity are warranted.