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Prostate Cancer?
Dec 16, 2006

HIV+, on meds since May, undetectable VL, cd4 225 17%. Was diagnosed with undesseminated MAC in my colon a year ago, and I've been on euthambutol and biaxin since then. Recently, my PSA jumped from .87 in September to 2.26 in November, and my doctor ordered a prostate sonogram. The sonogram showed no tumors, but did show what the doctor said was calcification, probably from prostatitis (of which I have been unaware.) Now he has scheduled me for a prostate biopsy, to ensure that the calcification is not malignant.

So I'm pretty scared, even though the doc doesn't seem overly concerned. Is there a correlation between HIV and prostate cancer? I thought I read somewhere that with the healing of MAC, calcification sometimes results. Any chance they are related? Just when I thought I was getting my HIV under control, this is really stressing me out. Your input will be very much appreciated.

Response from Dr. Wohl

Prostate cancer is a common problem in men. In fact, studies show that all men wil get some prostate cancer if they live long enough. The good news is that these are generally slow growing cancers and most men die of some other problem associated with old age before they even know about their prostate cancer.

Now, you may not even have prostate cancer. The PSA is a notoriously imprecise test. Internal medicine guidelines do not even recommend it for prostate cancer screening goven its problems - including elevations falsely leading to fear and additional testing. Urologists feel differently and use the test widely.

Now that you have had the test, though, you understandably feel compelled to follow-up and get additional invasive testing,

There is no correlation that I am aware of between HIV and prostate cancer. HIV can reduce the ability of the immune system in monitor for tumors and attack cancerous cells. Therefore, there are some cancers that exploit this weakness that clearly are linked to HIV but prostate cancer is not one of these.

Some caveats: Many men with HIV take testosterone or similar hormones. Prostate cancer is sensitive to these hormones. The result is that testosterone and like drugs can help these cancer cells grow once they develop. Although there are no clear links between HIV and prostate cancer, I think keeping your immune system working as best as it can is important to controlling and preventing cancer.

Hopefully all this is moot and you do not have prostate cancer but are merely another victim of the PSA.

DW



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