Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) appear to be at lower risk for infection by the coronavirus that causes COVID-19, according to a new report.
In a study of men with PCa in Veneto, an Italian region especially hard hit by COVID-19, only 4 of the 5273 patients receiving ADT became infected with the SARS-CoV-2 coronavirus compared with 114 of the 37,161 not receiving ADT. Compared with ADT recipients, the no-ADT group had significant 4-fold increased odds of testing positive for SARS-CoV-2, a team led by Andrea Alimonti, MD, of the Università della Svizzera Italiana in Bellinzona, Switzerland, reported in Annals of Oncology.
Study findings showed that patients with any type of cancer have an increased risk for SARS-CoV-2 infection compared with patients not diagnosed with cancer. For example, of Veneto’s total male population of 2.4 million, 0.2% of patients without cancer tested positive for SARS-CoV-2 compared with 0.3% of those with cancer, Dr Alimonti and his colleagues reported.
The authors speculated that the apparent protective effect of ADT may involve inhibition of TMPRSS2, a serine protease involved in multiple physiologic and pathologic processes, including cancer and viral infection. Previous studies have implicated TEMPRSS2 as a critical host cell factor for the spread of several clinically relevant viruses, including SARS-CoV and MERS-CoV coronaviruses. TEMPRSS2 is highly expressed in localized and metastatic PCa, and its transcription is regulated by androgen receptors (ARs). ARs have been shown to regulate TMPRSS2 expression in non-prostatic tissue, including the lung. “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 with women.”
They also observed, “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 androgen deprivation therapies (ADTs) may protect patients affected by prostate cancer from SARS-CoV-2 infections.”
In a discussion of study limitations, Dr Alimonti and his colleagues noted that cancer patients infected with SARS-CoV-2 are more often hospitalized than non-cancer patients, so they may have been tested for the coronavirus at a higher rate. “This may explain the higher prevalence of infected individuals in the cancer patient population,” the investigators wrote.
In addition, PCa patients receiving ADT may practice more social distancing than PCa patients not receiving ADT and cancer patients overall.
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) [published online May 6, 2020]. Ann Oncol. 2020; S0923-7534(20)39797-0. doi: 10.1016/j.annonc.2020.04.479