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Prostate Cancer and HIV-- What should I do?
Dec 28, 2001

I am a 50-year old male, diagnosed with HIV in the mid-80s. Currently undetectable with CD4 cells holding in the 500 range. I exercise regularily (more like an obsession to be truthful!), and take good care of myself via diet, stress, etc.

I recently had a PSA done, and it came back slightly elevated at 7.5. A subsequent biopsy revealed cancer on one of the eight cuts at 2, and I was given a Gleason score of 6, indicating moderately aggressive cancer. The urologist feels that I would be a good candidate for implantation of radioactive "seeds" (brachytherapy) in the prostate as opposed to a radical prostatectomy or external beam radiation. Given the horrible side effects of the later treatments, I'm inclined to go along with the idea of the seed treatment option.

The one thing I am concerned about is whether the brachytherapy would negatively impact my HIV status. I've been doing so good, for so long, that I am upset that something like this could send me in a medical tailspin. My specialists tell me that this is a whole new area...older HIV'ers going through prostate cancer treatment, so no one knows. I'll be one of the prioneers...lucky me, huh? Do you think I have reason to be concerned? I keep thinking that maybe having the surgery to remove the prostate would be better than subjecting my already compromised immune system to on-going internal radiation. And then again, the after-effects of the prostatectomy scare the hell out of me. It's one thing to battle HIV, but to take on cancer compounds the issue.

Any thoughts on this?

Response from Dr. Dezube

Although prostate cancer is not an AIDS-defining cancer, we are indeed seeing more of it as HIV'ers live longer. Most commonly it is seen in the setting of testosterone supplementation. Are you on testosterone supplements of any kind? If so, you must stop them immediately since they can cause the prostate cancer to flare. Testosterone supplementation is very common among many HIV patients. For those of you on testosterone supplements, it's a good idea to have the PSA checked regulary (e.g. annually) to catch prostate cancer in the early stage.

In terms of treatments, depending on the stage, either prostatectomy or radiation treatments are usually, but not always, curative. My own feeling is that radiation treatments are much better tolerated than and are as effective as prostatectomy. Radiation has a better track record than surgery when it comes to side effects such as impotence, incontinence, and dribbling. As you query indicates, radiation therapy can be given as external beam (about 5 weeks of radiation therapy) or as a single treatment of radioactive seeds. A single treatment of radioactive seeds is obviously much easier to tolerate than 5 weeks of external beam treatment. So if your radiation therapist and your urologist feel you are a candidate for radioactive seeds, then I would go for it. Not every patient is a candidate for radioactive seeds. Doctors make this determination based on the prostate size and the Gleason score. A Gleason score of 6 is a good score. The Gleason score measures the aggressiveness of the tumor.

One additional thing, I usually recommend 6 months of hormone treatment with either Zoladex or Lupron. This makes the radioactive seeds work more effectively. Since one hormone injection lasts for 3 months, I would recommend that you get a hormone injection now; then 2-3 months later that you get the radioactive seeds; and then afterwards that you get a second injection. That would give you the most insurance against recurrence.

Your prognosis is excellent. There should be NO impact on your HIV. And please remember, that you should probably NEVER be on testosterone supplements in the future.

Good luck! yours, BD


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