Prostate cancer radiotherapy safe for HIV patients

NEW YORK (Reuters Health) - The results of small study suggest that radiotherapy can be safely used to treat prostate cancer in HIV-infected men. Treatment appears to have no long-term effect on CD4+ cell count or viral load.

When considering radiotherapy for prostate cancer, there is no reason that HIV-infected patients should be treated differently than their HIV-negative peers, senior author Dr. Anthony M. Berson, from St. Vincent’s Hospital in New York, and colleagues conclude.

The study, reported in the medical journal Urology, included 14 HIV-infected patients with prostate cancer who were treated with external beam radiotherapy or brachytherapy, a method in which radioactive “seeds” emitting continuous radiation are implanted in the tumor. Some patients received both treatments.

Levels of prostate-specific antigen (PSA), a protein detected in the blood that increases with prostate cancer risk or progression; CD4+ cell count, immune system cells that decline with HIV disease progression; and HIV levels were assessed at the beginning of the study and again at the latest follow-up, which ranged from 8 to 73 months.

During follow-up, only one patient had a PSA level that was still above 1.1 ng/mL, the report indicates. PSA levels between 0.0 and 2.5 ng/mL are considered low.

The average CD4+ cell count rose slightly during follow-up from 523 to 577 cells/microliter. Normal CD4+ counts range between 500 and 1600 cells/microliter. The lowest final count was 200 cells/microliter, the investigators note. When CD4+ cell counts drop below 200 cells/microliter, HIV infection has progressed to AIDS.

Only two patients experienced an increase in viral load, indicating HIV disease progression.

Radiotherapy was not associated with any unusual urinary, rectal, or sexual complications, and no infections were seen in the study group, Berson’s team states.

The researchers call for larger studies to definitively assess the possible adverse side effects for HIV-infected patients who undergo prostate cancer treatment.

SOURCE: Urology, November 2008.

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