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

Background: HIV-infected (HIV⁺) men face cancer treatment disparities that impact outcome. Prostate cancer 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 prostate cancer and 86 age- and race-matched HIV-uninfected (HIV^-) controls with prostate cancer, ages 40 to 79 years, from 2001 to 2012. We defined treatment appropriateness using National Comprehensive Cancer Network guidelines and the Charlson comorbidity index (CCI) to estimate life expectancy. Results: Median age was 59.5 years at prostate cancer diagnosis. Median CD4⁺T-cell count was 459.5 cells/ mm3, 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy was the primary treatment for 39.5% of HIV⁺and 71.0% of HIV^- men (P = 0.004). Only 16.3% of HIV⁺versus 57.0% of HIV^- men received open radical prostatectomy (P < 0.001). HIV⁺men received more radiotherapy (25.6% vs. 16.3%, P = 0.13). HIV was negatively associated with open radical prostatectomy (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 four 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: Prostate cancer 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 radical prostatectomies, specifically open radical prostatectomies. Impact: Research on HIV/AIDS survival indices and etiologies and outcomes of this prostate cancer treatment disparity in HIV⁺men are needed.