Prostatectomy Safe When HIV Is Asymptomatic (Reuters Health)
August 22, 2006 (Reuters Health)—Radical prostatectomy can be safe and effective in
selected HIV-positive patients who are asymptomatic, have higher CD4+
cell counts, and have albumin levels in the normal range. 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 radical prostatectomy at
their institution between 2002 and 2005. Dr. Peter T. Scardino and
colleagues analyzed patient outcome to determine factors for surgical
risk. Their findings are published in the August issue of BJU
International.
Preoperative CD4+ counts ranged from 269 to 870 cells/microliter.
Viral loads ranged from below 50 copies/mL to 18,700 copies/mL. Three
patients were on HAART.
Two patients developed incisional wound infections, with one patient
requiring rehospitalization for intravenous antibiotics. This patient
had the lowest CD4+ count in the series.
None of the patients progressed to AIDS or had biochemical
recurrence of prostate cancer during a median of 26 months of follow-up.
Co-author Dr. James A. Eastham told Reuters Health that "HIV status
would not change the surgical approach. However, if a patient had
symptomatic AIDS and his life expectancy was limited and his immune
system severely compromised, a radical prostatectomy would rarely be
indicated. In this case, we would recommend palliative management of
symptoms from the prostate cancer."
"Today, men who are HIV positive have a very long life expectancy
and we generally treat them as we would anyone else with prostate
cancer," Dr. Scardino said.
