ADT Might Protect Prostate Cancer Patients Against SARS-CoV-2 Infection

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Men using androgen deprivation therapy (ADT) for prostate cancer may be less susceptible to SARS-CoV-2 infection than other cancer patients, Italian data suggests. 

As described in the Annals of Oncology, the team examined data from 9280 patients with a confirmed diagnosis of COVID-19 who had attended one of 68 hospitals in the Veneto region of Italy by 1 April 2020. 

Overall, the 4532 male patients were more likely than their 4748 female counterparts to require intensive care unit admission (78 vs 22%), be admitted to hospital (60 vs 40%) and not survive (62 vs 38%), the researchers report. 

The team further examined the rate of SARS-CoV-2 infection among these men, who accounted for 0.2% of the total male Veneto population and 0.3% of male cancer patients. 

“Strikingly, only 4 out of 5273 patients receiving [ADT] in Veneto developed SARS-CoV-2 infection and none of these patients died”, report Andrea Alimonti, from Università della Svizzera Italiana in Bellinzona, Switzerland, and co-workers. 

This compared with 114 cases of COVID-19 among the 37,161 prostate cancer patients not using ADT, and 312 cases among the 79,661 patients with other types of cancer, resulting in significant odds ratios of 4.05 and 5.17, respectively.  

The researchers note that these discrepancies occurred despite male cancer patients overall being a significant 1.79 times more likely to have SARS-CoV-2 infection than other male patients, as well as being more likely to require hospital admission (67.9 vs 47.0%) or die (17.4 vs 6.9%). 

And the increased risk of SARS-CoV-2 hospitalisation and mortality among male cancer patients versus non-cancer patients persisted even after adjusting for age, emphasize Andrea Alimonti et al. 

“Altogether, these data indicate that androgen deprivation in prostate cancer patients is associated with a reduced probability to develop SARS-CoV-2 infections and with more positive infection outcomes”, they postulate.

The researchers explain that SARS-CoV-2 enters cells via binding to the angiotensin-converting enzyme 2 and proteolytic cleavage of the viral S protein by TMPRSS2, expression of which is regulated by the androgen receptor. 

“The androgen-dependent regulation of TMPRSS2 expression in the lung may explain the increased susceptibility of men to develop SARS-CoV-2 severe infections when compared to women”, the authors suggest. 

“Given that TMPRSS2 levels are under the control of androgens not only in the prostate but also in the lung, we put forward the hypothesis that [ADTs] may protect patients affected by prostate cancer from SARS-CoV-2 infections”, they conclude. 

Reference  

Montopoli M, Zumerle S, Vettor R, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (n=4532). Ann Oncol; Advance online publication 6 May 2020. doi:10.1016/j.annonc.2020.04.479