Contrary to a previous report, use of androgen deprivation therapy (ADT) does not appear to reduce the risk for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, according to a recent study.
In May 2020, investigators published results from a small Italian study in the Annals of Oncology suggesting 4-fold increased odds of SARS-CoV-2 infection among 114 ADT nonusers compared with 4 ADT users. ADT was hypothesized to downregulate transcription of the TMPRSS2 gene expressed in the lungs as well as the prostate. TMPRSS2 was recently implicated as playing a role in priming SARS-CoV-2 within the host.
In the current study, published in the Journal of Urology, Eric A. Klein, MD, of the Glickman Urological and Kidney Institute at Cleveland Clinic in Cleveland, Ohio, and colleagues examined a larger cohort and found no significant difference in infection risk between ADT users and nonusers after a multivariable analysis.
In the cohort of 74,787 individuals in a US health system undergoing SARS-CoV-2 testing, 102 (5.7%) of 1779 men with prostate cancer tested positive for the virus. Positive test results were observed for 5.6% of 304 men on ADT and 5.8%, of 1475 men not on ADT, a difference that was not statistically significant.
Known risk factors for SARS-CoV-2 infection or mortality were evenly distributed between groups including asthma, diabetes mellitus, hypertension, coronary artery disease, heart failure, and immune suppressive disease. Men receiving ADT, however, were significantly older (75.5 vs 73.8 years) and significantly more likely to have smoked (68.1% vs 59.3%) and taken steroids (43.8% vs 23.3%).
“Routine use of ADT in patients at risk for or affected by COVID-19 is not warranted in the absence of controlled clinical trials showing benefits for prevention, mitigation of disease severity or improved survival,” according to Dr Klein’s team.
Klein EA, Li J, Milinovich A, et al. Androgen deprivation therapy in men with prostate cancer does not affect risk of infection with SARS-CoV-2. J Urol. 2021;205:441-443. doi:10.1097/JU.0000000000001338