Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532)

M Montopoli, S Zumerle, R Vettor, M Rugge, M Zorzi, C V Catapano, G M Carbone, A Cavalli, F Pagano, E Ragazzi, T Prayer-Galetti, A Alimonti, M Montopoli, S Zumerle, R Vettor, M Rugge, M Zorzi, C V Catapano, G M Carbone, A Cavalli, F Pagano, E Ragazzi, T Prayer-Galetti, A Alimonti

Abstract

Background: Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on binding of the viral spike (S) proteins to angiotensin-converting enzyme 2 and on S protein priming by TMPRSS2. Inhibition of TMPRSS2 may work to block or decrease the severity of SARS-CoV-2 infections. Intriguingly, TMPRSS2 is an androgen-regulated gene that is up-regulated in prostate cancer where it supports tumor progression and is involved in a frequent genetic translocation with the ERG gene. First- or second-generation androgen-deprivation therapies (ADTs) decrease the levels of TMPRSS2. Here we put forward the hypothesis that ADTs may protect patients affected by prostate cancer from SARS-CoV-2 infections.

Materials and methods: We extracted data regarding 9280 patients (4532 males) with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the coronavirus disease 2019 (COVID-19) pandemic. The parameters used for each COVID-19-positive patient were sex, hospitalization, admission to intensive care unit, death, tumor diagnosis, prostate cancer diagnosis, and ADT.

Results: There were evaluable 9280 SARS-CoV-2-positive patients in Veneto on 1 April 2020. Overall, males developed more severe complications, were more frequently hospitalized, and had a worse clinical outcome than females. Considering only the Veneto male population (2.4 million men), 0.2% and 0.3% of non-cancer and cancer patients, respectively, tested positive for SARS-CoV-2. Comparing the total number of SARS-CoV-2-positive cases, prostate cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared with patients who did not receive ADT (OR 4.05; 95% CI 1.55-10.59). A greater difference was found comparing prostate cancer patients receiving ADT with patients with any other type of cancer (OR 4.86; 95% CI 1.88-12.56).

Conclusion: Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with non-cancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2 infections.

Keywords: COVID-19; androgen-deprivation therapy; prostate cancer.

Conflict of interest statement

Disclosure The authors have declared no conflicts of interest.

Copyright © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Percentage of patients infected with SARS-CoV-2 divided by sex showing an increased severity of COVID-19 in males.
Figure 2
Figure 2
Percentage of male patients infected with SARS-CoV-2 in Veneto divided by hospitalization, ICU, and death.

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Source: PubMed

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