Prostate surgery safe for some men with HIV

NEW YORK (Reuters Health) - HIV-positive patients can safely undergo surgery for prostate cancer, as long as they are generally in good shape with reasonable immune function. These patients do about as well as HIV-negative patients, according to a team at Memorial Sloan-Kettering Cancer Center in New York.

Seven men with HIV infection underwent complete prostate removal at their institution between 2002 and 2005. Dr. Peter T. Scardino and colleagues analyzed the outcomes, and report their findings in urology journal BJU International.

Pre-operative CD4 cell counts, a measure of immune function, ranged from 269 to 870, and viral loads ranged from below 50 to 18,700. Three patients were on highly active anti-HIV drug regimens.

Two patients developed surgical wound infections, with one patient requiring re-hospitalization in order to be treated with intravenous antibiotics. This patient had the lowest CD4 count among the seven patients.

None of the men progressed to full-blown AIDS or had recurrence of prostate cancer during an average follow-up of 26 months.

Co-author Dr. James A. Eastham told Reuters Health that "HIV status would not change the surgical approach."

He noted that nowadays "men who are HIV positive have a very long life expectancy and we generally treat them as we would anyone else with prostate cancer."

However, if a man has advanced HIV disease, radical surgery might not be worth the risk, Scardino explained. In that case, he would recommend palliative treatment of any symptoms that might arise from prostate cancer.

SOURCE: BJU International, August 2006.