Alarmingly High Rate of Prostate Cancer Detected by Routine Prostate-Specific Antigen Screening in a County HIV Clinic

BACKGROUND: Routine prostate-specific antigen (PSA) screening in the general population and in HIV-infected men is controversial. The aim of this study is to determine the prevalence of prostate cancer (PC) among patients living with HIV (PLWH). METHODS: After an index case of PC was detected by sporadic PSA screening, we performed a prospective (2/2010–10/2016) cohort study following PSA levels and biopsies of African-American (AA) men ≥45 years and non-AA men ≥50 years. Screening was done at the discretion of the provider. RESULTS: Of the 124 men (82 AA, 17 Hispanic, 16 Caucasian, 7 Asian, 2 other) who received PSA screening, 7 (5.6%) had a PSA > 5 and underwent prostatic biopsy. Five patients (4%) were found to have PC, all of whom had a history of good long-term HIV virologic control. Mean age of PC patients was 60 years vs. non-PC patients (55 years) (P = 0.031). Mean years of HIV in PC patients was 18 years vs. non-PC patients (14 years) (P = 0.068). CONCLUSION: PSA screening is controversial and not universally recommended. Other retrospective studies of PLWH have shown equally high rates of PC. Compared with the general population (1/1,000 non-AA and 1.7/1,000 AA), men in our cohort had a 25 times higher rate (4%)of PC. All patients had aggressive tumors and required surgery, including one patient with metastasis to regional nodes. As expected, age was a significant risk factor for PC. We recommend implementing routine cohort PSA screening in PLWH. DISCLOSURES: All authors: No reported disclosures.