Prostate cancer diagnosed later in US men with HIV

[Jim Allen]

Reminder to get your prostate checked.

Aidsmap article in full: https://www.aidsmap.com/news/mar-2024/prostate-cancer-diagnosed-later-us-men-hiv

In Brief:

Men with HIV in the US’s largest care provider for people with HIV were more likely to be diagnosed late with prostate cancer and less likely to undergo testing that may warn of an increased prostate cancer risk, the Conference on Retroviruses and Opportunistic Infections (CROI 2024) in Denver heard this week.

In this analysis, researchers matched men with HIV diagnosed with prostate cancer between 2001 and 2018 with at least two men without HIV who had been diagnosed with prostate cancer during the same period.

The study identified 751 men with HIV diagnosed with prostate cancer and matched them with 2778 men without HIV also diagnosed with prostate cancer.

Men with HIV had significantly higher PSA levels at diagnosis (6.8 vs 6.3, p=0.005) and a significantly higher proportion had metastatic cancer at diagnosis (indicating late diagnosis) (4.3% vs 2.8%, p=0.048). However, there was no significant difference in the stage at which tumours were diagnosed when the Gleason score for each tumour was analysed (low-risk, intermediate or high-risk).

Did a lack of PSA testing in people with HIV explain diagnosis at a later stage? PSA testing is an imprecise tool for predicting prostate cancer risk; in the United Kingdom it is not carried out routinely for this reason. The US Preventive Services Taskforce says that it only offers a small potential benefit for men aged 55-69 and doesn’t recommend its use in the over-70s.

Although PSA testing increased over time, testing was consistently less frequent in people with HIV across all time periods and age groups, so that men with HIV were 1.25 times less likely to undergo PSA testing prior to prostate cancer diagnosis (p<0.001). The gap was especially pronounced in the oldest patients: in those diagnosed between 2015 and 2018, men without HIV aged 75 and over had received an average of 19 PSA tests by the time they were diagnosed compared with 13 for men with HIV.

People with HIV were more likely to die after diagnosis if they had intermediate- or high-risk tumours, but when the cause of death was restricted to prostate cancer alone, there was no significant difference in the risk of death at any cancer stage.