Background:  The widespread use of ART has resulted in a significant increase in life expectancy of HIV-infected persons. Several non-AIDS-defining malignancies have emerged as significant problems, but there are few data about the incidence of prostate cancer or guidelines for screening in this population.

Methods:  We reviewed all diagnoses of prostate cancer in the HIV Atlanta Veterans Administration Cohort Study (HAVACS), a prospective study of 2999 patients followed since 1982. We also determined changes in potential risk factors including race and age, and trends in prostate-specific antigen (PSA) testing.

Results:  A total of 27 patients have been diagnosed with prostate cancer since 1982; 17 cases occurred since 2003. The incidence since 2003 is 4.6 cases per 1000 compared with 1.0 cases per 1000 before 2003 (p <0.00006). All but 4 were >50 years old at the time of diagnosis. African Americans accounted for 22 of 27 cases (81.5%). Of interest, prostate cancer was diagnosed before HIV in 6 patients (range of 4 months to 16 years). For those with a preceding HIV diagnosis, the average time of cancer diagnosis was almost 10 years after HIV diagnosis. For these same patients the mean CD4 and HIV viral load at the time of prostate cancer diagnosis was 432 cells/mm³ and 2055 copies/mL, respectively. The PSA value was >4.0 ng/mL in all cases (range 4.1 to 30.6, mean 11.6). Standard screening of this population with PSA testing for those age >50 has been stable for many years. The rate of testing for PSA increased markedly since 1997, corresponding to a rapidly growing population over age 50 (see the figure).

Conclusions:  Prostate cancer should be added to the malignancies now being seen in HIV-infected patients. The known risk factors of age and race appear to remain the same regardless of HIV status.