August 22, 2006 (Reuters Health)—Radical prostatectomy can be safe and effective inselected HIV-positive patients who are asymptomatic, have higher CD4+cell counts, and have albumin levels in the normal range. Thesepatients do about as well as HIV-negative patients, according to a teamat Memorial Sloan-Kettering Cancer Center in New York.

Seven men with HIV infection underwent radical prostatectomy attheir institution between 2002 and 2005. Dr. Peter T. Scardino andcolleagues analyzed patient outcome to determine factors for surgicalrisk. Their findings are published in the August issue of BJUInternational.

Preoperative CD4+ counts ranged from 269 to 870 cells/microliter.Viral loads ranged from below 50 copies/mL to 18,700 copies/mL. Threepatients were on HAART.

Two patients developed incisional wound infections, with one patientrequiring rehospitalization for intravenous antibiotics. This patienthad the lowest CD4+ count in the series.

None of the patients progressed to AIDS or had biochemicalrecurrence of prostate cancer during a median of 26 months of follow-up.

Co-author Dr. James A. Eastham told Reuters Health that “HIV statuswould not change the surgical approach. However, if a patient hadsymptomatic AIDS and his life expectancy was limited and his immunesystem severely compromised, a radical prostatectomy would rarely beindicated. In this case, we would recommend palliative management ofsymptoms from the prostate cancer.”

“Today, men who are HIV positive have a very long life expectancyand we generally treat them as we would anyone else with prostatecancer,” Dr. Scardino said.




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