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Does HIV Increase Prostate Cancer Risk?
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Increased Prostate Cancer Incidence in Aging Population HIV+
The incidence of prostate cancer has increased dramatically in this aging cohort of HIV infected patients. Several non-AIDS-defining malignancies have emerged as significant problems, but there are few data about the incidence of prostate cancer or guidelines for ...
www.natap.org/2007/CROI/croi_67.htm
prostate is a reservoir for HIV.
Persistent and Pesky: residual replicating HIV and latent ...
Persistent and Pesky: residual replicating HIV and latent reservoirs including genital secretions. Written by David Margolis, MD, University of Texas, Southwestern Medical Center
Male genital secretions are a complex mixture of cells and secretions from the testes, epidydimis, vas deferens, seminal vesicles, prostate, urethral, ...
www.natap.org/2003/Retro/day7.htm
The author's conclude these data suggest that the prostate is a reservoir for HIV. This has significant transmission consequences, as prostate massage resembles receptive anal intercourse in men who have sex with men. Prostate stimulation via anal intercourse could therefore increase the amount of HIV RNA in the receptive partner'' genital secretions, which could then be transmitted when he becamethe insertive partner. These data could, in part, explain the high HIV infection rates historically seen in men who have sex with men. (abs 459a, "The Prostate as a Reservoir for HIV-1", Smith, Kingery, Ignacio, Wong, Richman, Little, Univ of California, San Diego and Loma Linda Univ, CA)
HIV and prostate cancer: a systematic review of the literature
Although a study reported below found the prostate to be a reservoir for HIV and that immunosuppression and immune dysregulation might predispose an HIV+ man to prostate cancer the finding of this large study is that they did not find a higher prevalence of prostate cancer in men, a review of the literature found however mixed results leading authors to say proper studies probab;y have not been conducted to provide a good answer to this question.
The true incidence of prostate cancer in this population is unknown. In the few cases that have been presented in the literature, prostate cancer in ...
www.natap.org/2008/HIV/090808_01.htm
Prostate Cancer and Prostatic Diseases advance online publication 19 August 2008
"Interestingly HIV protease inhibitors have been demonstrated to decrease proliferation of PCa cells via inhibition of nuclear factor-B"
"Conclusion: Patients with HIV are living longer in large part because of new innovations of viral treatment. As this trend continues, these patients are at risk of secondary malignancies. The incidence of PCa may theoretically be increased in HIV-positive patients because of immunosupression and because other tumors occur with increased frequency. There is mixed evidence of a relationship between HIV and PCa incidence. Some have suggested that HIV-positive cohorts are inadequately screened for PCa, but in the few prospective screening studies a higher prevalence of PCa has not been detected. The HIV-positive men who are diagnosed with PCa often have tumors and demographics that are not dissimilar to age-matched cohorts. The life expectancy of modern HIV-positive men warrants consideration for treatment for PCa similar to age- and comorbidity-matched men. Although there are limited data on outcomes, HIV-positive men do appear to tolerate surgical or radiotherapeutic interventions with little increased morbidity. Future studies should be aimed at using age-appropriate PSA screening and characterizing long-term outcomes of this patient population."
"Based on these and several other large retrospective population-based studies, it is difficult to determine if there is an increased or decreased incidence of HIV in an age-matched general population.25, 26 These observation-based, epidemiologic studies simply look at incidence of PCa in an HIV-positive cohort which is dependent on detection and, thus, PSA and DRE screening. It has been hypothesized that reports of lower incidence of PCa in HIV positive individuals may be due to decreased screening of this group.16, 23"
"Testosterone: Hypogonadism is more prevalent in the HIV-positive population, with prevalence rates about 20% higher than age-matched controls.37 The etiology of this hypogonadism is unclear but may be related to a combination of factors, including HIV, HAART, malnutrition and opportunistic infections. Hypogonadism may result in or contribute to reduced bone mineral density and muscle mass, poor mood, anemia, decreased libido and erectile dysfunction. Testosterone replacement therapy helps improve these conditions and is often prescribed for hypogonadal men with HIV. Testosterone replacement has been linked, albeit not definitely, to an increased risk of development of PCa. Although it is universally agreed that men with elevated PSA or abnormal DRE findings should undergo a prostate biopsy before initiating testosterone replacement therapy, there is no generally agreed upon monitoring regimen for PCa in patients with normal PSA and DRE findings. Some authors advocate a prostate biopsy before initiating testosterone replacement therapy even in men with normal DRE results and PSA levels.38 This is a particularly important and difficult issue in the HIV-positive population because the incidence and relationship between PCa and HIV are unclear. There are very limited data on this topic but Pantanowitz et al.10 reported that in their series of 13 men with a known diagnosis of HIV before a diagnosis of PCa, 3 had received testosterone therapy. If HIV truly does represent a risk for PCa, then more rigorous screening may be necessary in this group as a whole, and especially in those on testosterone replacement therapy. At this point in time no definitive recommendations can be offered but it should be noted that many men with HIV are receiving testosterone replacement and are not adequately being screened."
Prostate Cancer Foundation
As you may know over the past 2 years there has been a lot of discussion about inflammation in HIV. The SMART Study started this discussion 2 years ago by finding inflammation markers increased during treatment interruption and inflammation markers increase was associated with viral replication in patients in this study who took interruptions and inflammation markers increase was associated with all cause mortality to increase. Do you check inflammation markers? It's a simple process when you give blood to the lab at your doctor's visit you can request they check inflammation markers. The markers examined in the SMART Study included hsCRP, TNF-alpha and IL-6. I agree with the discussion below that regular exercise and the correct diet has an important affect on inflammation. I suspect that intense aerobic exercise suppresses inflammation, like running, biking or swimming 3-5 days a week at a good pace for 45 minutes each time. And the article below reviews diet. Jules Levin, NATAP
Effects of Oxidation and Inflammation, Cancer, Prostate Cancer
Oxygen is essential to life, but the chemistry of oxygen and oxidation drives cancer development. Oxidation is a normal chemical reaction that occurs when free radicals form within the cells of the prostate. Each oxygen atom contains two electrons that cling together. When heat or light breaks apart the atom, the electrons are separated, leaving unpaired oxygen radicals. These radicals are free to roam around and initiate a process of breaking down normal cellular structures, causing damage and promoting the development of cancer. The more free radicals present, the more cancer causing damage occurs.
This process is similar to what happens during the browning of an apple after it is sliced open and the flesh of the apple is exposed to the oxygen in the air. The oxygen atoms in the air interact with the sugar in the apple, forming oxygen radicals. These radicals break down the flesh of the apple, or oxidize it, and the apple begins to rot.
As long as the outer peel of the apple protects the inner flesh from oxygen, it is not oxidized. But when protective "antioxidants" are removed, the damage from oxidation is allowed to occur unimpeded. Likewise, our bodies have many sophisticated defenses against oxidation. But when these defenses break down, cancerous cells form and are allowed to grow.
One of the most common causes of the loss of protective antioxidants is inflammation, a biochemical process that your body initiates when fighting off an infection. If the body senses invaders, such as bacteria, white blood cells are mobilized to go to the site of the invasion and to release oxygen and nitrogen radicals to help kill the invaders. Unfortunately, if they remain unchecked, these same oxygen radicals can also break down normal tissue and promote the development of cancer. Oxygen radicals damage normal DNA, causing errors that allow cancer growth.
In fact, investigators have noted the presence of inflammatory cells in virtually all prostate cancer tissue that is removed surgically, and have found that inflammation leads to the atrophy, or wasting away, of normal prostate tissue adjacent to precancerous and cancerous areas of prostate tissue.
Based on these and other observations, evidence is mounting that inflammation and oxidation play key roles in the development of prostate cancer. Why is this important? Because although other contributory factors such as aging and altered hormone secretions are difficult or impossible to change, nutritional and exercise habits that reduce the development of inflammation and oxidation can be changed.
There are many anti-inflammatory and antioxidant substances found in colorful fruits and vegetables, whole grains, and spices - nearly all of which are absent from the processed foods that rely on sugar, salt, and fat for flavor. By focusing your diet on fresh fruits and vegetables, ocean-caught fish, and whole grains, you can increase the protective antiinflammatory components of your diet and begin to benefit from their effects.
For example, tomato-based products such as soups, pasta, and juices can increase levels of the antioxidant lycopene in the prostate gland. Drinking beverages such as pomegranate juice and green and black tea can increase levels of antioxidant-containing polyphenols. The cruciferous vegetables such as broccoli, Brussels sprouts, bok choy, wasabi mustard, and horseradish all contain substances that may induce protective proteins in your liver and tissues, while vitamins, minerals, extracts of fruits and vegetables, herbs, and spices can all act against both oxidation and inflammation.
Finally, recent research has suggested that regular exercise may be one of the best natural antioxidants. Regular exercise causes many changes in your body that help reduce circulating levels of reactive oxygen inflammation. Beyond burning calories, endurance-type exercises, such as walking, running, cycling, and swimming, are particularly effective at increasing the body's natural levels of antioxidants, eliminating inflammatory molecules that drive cancer.
Prostate Information
Screening for prostate cancer can be performed quickly and easily in a physician's office using two tests: the PSA (prostate-specific antigen) blood test, and the digital rectal exam (DRE).Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men.
The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact, more than 65% of all prostate cancers are diagnosed in men over the age of 65.
The prostate is a small, squishy gland about the size of a walnut that sits under the bladder and in front of the rectum. The urethra, the narrow tube that runs the length of the penis and that carries both urine and semen out of the body, runs directly through the prostate; the rectum, or the lower end of the bowel, sits just behind the prostate and the bladder. Sitting just above the prostate are the seminal vesicles, two little glands that secrete about 60% of the substances that makes up semen; running alongside and attached to the sides of the prostate are the nerves that control erectile function.
Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors. The term "cancer" refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process. Unlike normal cells, the growth of cancer cells is no longer well-regulated. Instead of dying as they should, cancer cells outlive normal cells and continue to form new, abnormal cells.
Abnormal cell growths are called tumors. The term "primary tumor" refers to the original tumor; secondary tumors are caused when the original cancer spreads to other locations in the body. Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect.
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