ADT for prostate cancer reduces COVID-19 risk

Men treated for prostate cancer with androgen deprivation therapy (ADT) were at significantly lower risk of COVID-19 infection, a large retrospective study of Italian patients showed.

Of the 5,273 men treated with ADT, only four were positive for the new coronavirus, one was severe and none died. This was compared to 114 COVID-19 cases among 37,161 men with prostate cancer but no ADT, with 31 serious illness and 18 deaths.

Absolute numbers translate into a low risk of one-quarter of COVID-19 infection in prostate cancer patients treated with ADT, as well as the probability of developing severe disease. The results suggest that ADT may have the potential to treat or prevent COVID-19. Andrea Alimonti, MD, is from the University of Svizzera Italiana in Bellinzona, Switzerland. Oncology records..

“These data need to be further validated in an additional large cohort of SARS-CoV-2 infected patients to correct for multiple variables,” the authors conclude. “Luteinizing hormone releasing hormone agonist/antagonist or AR-based ADT [androgen receptor] Inhibitors may reduce SARS-CoV-2 infection or complications in high-risk male populations. Given that the effects of these compounds are reversible, they can be used transiently in patients affected by SARS-CoV-2, reducing the risk of side effects from long-term administration. “

This study could provide a feed for scientific debate about the potential treatment or prevention of ADT, especially in COVID-19-especially another study Urology Dr. Eric Klein, MD, Cleveland Clinic, said he had reached another finding and conclusion.

“It’s an interesting question, but I don’t know the answer at this time,” Klein said. MedPage today on mail.

Alimonti and co-workers have shown that cell entry by a novel coronavirus requires priming with TMPRSS2, a transmembrane serine protease involved in the spread of several clinically relevant viruses, including SARS and MERS coronavirus. It had its origin in the recognition that there is.

The authors note that a recent study of COVID-19 suggests that TMPRSS2 promotes fusion of the viral and cell membranes after the virus enters the cell. In a test tube Research shows that TMPRSS2 inhibition It may help prevent COVID-19 infections.

TMPRSS2 Is highly expressed in prostate cancer and its transcription is regulated by the androgen receptor, Alimonti and co-authors continued. Results of preclinical studies induced by androgen administration TMPRSS2 Expression and androgen deficiency is reduced in human lung epithelial cells TMPRSS2 Transcription in mouse lung tissue.

Given that background, the authors hypothesized that ADT “may protect patients affected by prostate cancer from SARS-CoV-2 infection.”

To pursue the hypothesis, the researchers relied on data from the registry, tumor registry, and pharmacy database of patients who tested positive for COVID-19 in the Veneto region of Italy. The team identified 9,280 patients (4,532 men) with laboratory confirmed infections at 68 hospitals. Male patients included 430 men with cancer (9.5%) and 118 men with prostate cancer (2.6%).

Overall, men with cancer were more severely ill, with 47.0 of all COVID-19 men requiring hospitalization and 6.9% dying, compared with a 67.9% hospitalization rate in the cancer men subgroup. The rate was 17.4%.

Age did not explain the difference between hospitalization and mortality, the authors said. The survey results are Another recent study COVID-19 infection rates are high in men with cancer, indicating that the disease is severe.

The data included a total of 42,434 men with prostate cancer in the Veneto region. Of these, 5,273 underwent ADT and four (0.08%) developed laboratory-verified COVID-19. The remaining 37,161 patients did not undergo ADT and 114 (0.3%) developed COVID-19. This difference translates into an odds ratio for infections of 4.05 in men not treated with ADT (95% CI 1.55-10.59, P= 0.0043).

One of the four ADT-treated patients who developed COVID-19 was severe and required an intensive care unit (ICU) stay. In contrast, 31 patients not receiving ADT had severe illness, 18 of whom died and 13 required ICU care. Patients who did not undergo ADT were more than four times more likely to be severe (OR 4.40, 95% CI 0.76-25.50, P= 0.0982).

Despite finding interesting data, Klein expressed reservations about key elements of the biological evidence presented by Alimonti and colleagues.

“TRMPSS2 is probably not under pulmonary androgen regulation, so it’s not clear how ADT affects its expression,” he said.