Abstract 171: Presentation and treatment of prostate cancer in HIV-infected men: Do racial disparities exist.
Authors: Bhatia Ramona , Achenbach Chad , Kittles Rick , Murphy Adam 
Published: August 2014

Introduction: Prostate cancer (PCa) is increasing among HIV-infected (HIV+) men who are living longer on effective anti-retroviral therapy (ART). African-American (AA) men are overrepresented in the HIV+ population and are at high risk for PCa and PCa-related health disparities. Little is known about PCa presentation and treatment utilization in HIV+ and HIV+AA men.

Methods: We conducted a retrospective analysis of HIV+ men with PCa seen at Northwestern Medicine in Chicago, IL, from 2001 to 2012. Cases identified through electronic medical record billing, encounter, and procedure codes were verified by chart review. We collected data on age, race/ethnicity, ART, CD4+ cell counts, and covariates for HIV and PCa. Descriptive and comparative statistical analyses were used.

Results: We studied 44 HIV+ men with a median age of 59.5 years at PCa diagnosis. There were 15 (34%) AAs, 25 (57%) Caucasians (CAs), two (5%) Hispanics, and two (5%) of unknown/other ethnicity. The majority (42/44 [95%]) were on ART with a median CD4+ cell count at PCa diagnosis of 372/μl (88-1215, ± 306). Median prostate specific antigen (PSA) at PCa diagnosis was 5.2 ng/ml (0.1-547, ± 102), and PSA did not differ between AAs and CAs (p=.83). Of the 34 men with clinical staging, 20 (59%) were cT1c, 11 (32%) cT2a, one (3%) cT2c, and two (6%) cT3 or higher. Stage at presentation was similar among AAs and CAs. Of all men with clinically localized (CL) disease in whom initial treatment was known, the majority (14/27 [52%]) underwent radical prostatectomy (RP) with most (9/14 [64%]) utilizing the robotic approach. Rates of RP in AAs and CAs were comparable (4/10 [40%] vs 9/15 [60%], p = 0.47). Radiation (including external beam (5, [19%]) and brachytherapy (2, [7%])) was used as primary therapy in seven (26%) men. Six (22%) elected watchful waiting/active surveillance. Overall, received treatments adhered to National Comprehensive Cancer Network recommendations for risk-appropriate therapy in 91% of men, with no disparities found between AAs and CAs (13/13 [100%] vs 15/17 [88%], p=.20).

Conclusions: HIV+ men are younger at PCa diagnosis compared to the general population (median age at diagnosis=67) and are likely to present with CL-PCa, regardless of race. Utilization of RP for CL-PCa and rates of overall appropriateness of therapy in HIV+ and HIV+ AAs are high and comparable to national data, suggesting no major treatment disparities based on HIV and racial status exist. Further studies on etiologies of early PCa presentation and RP- and cancer-related outcomes in HIV+ men are needed.

Citation Format: Ramona Bhatia, Chad Achenbach, Rick Kittles, Adam Murphy. Presentation and treatment of prostate cancer in HIV-infected men: Do racial disparities exist. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 171. doi:10.1158/1538-7445.AM2013-171