An Italian study investigating the prevalence and severity of COVID-19 in men with prostate cancer has revealed that patients treated with androgen-deprivation therapy (ADT) were less likely to develop COVID-19, and in those who were infected, the disease was less severe. Published in Annals of Oncology, the results of the study suggest that therapy, such as androgen-deprivation, could potentially be used to protect men from COVID-19 infection.
After learning of early COVID-19 research demonstrating that a Type II Transmembrane Serine Protease regulated by the androgen receptor, TMPRSS2, aided COVID-19 infection, Professor Andrew Alimonti and his team at Università della Svizzera Italiana (Bellinzona, Switzerland) set to work investigating the effect of ADT on vulnerability to COVID-19.
There are high levels of TMPRSS2 in prostate cancer patients. Therapies such as ADT target the androgen receptor in order to regulate TMPRSS2 action.
“This could explain why men infected by COVID-19 develop a more aggressive form of disease than women,” commented Alimonti. “It is known that ADT can decrease the levels of TMPRSS2 in prostate cancer patients, and some experimental evidence demonstrates that this could happen not only in the prostate but also in other tissues. So I wanted to see if ADT could decrease the risk of developing coronavirus infection in men with prostate cancer.”
Of the 4532 men, from the Veneto region of Italy, who were infected with COVID-19, 9.5% (430) had cancer and 2.6% (118) had prostate cancer. The team discovered that male cancer patients had a 1.8-fold increased risk of COVID-19 infection and developed a more severe disease.
However, upon reviewing all prostate cancer patients in the region, they found that only four out of 5273 men on ADT contracted COVID-19 and none of them died. They compared this with 37,161 prostate cancer patients who were not receiving this type of therapy, of whom 114 developed the disease and 18 died. Of the 79,661 with other cancers, 312 developed COVID-19 and 57 died.
“Patients with prostate cancer receiving ADT had a significant four-fold reduced risk of COVID-19 infections compared with patients who did not receive ADT,” reported Alimonti. “An even greater difference was found when we compared prostate cancer patients receiving ADT with patients with any other type of cancer; there was a more than five-fold reduction in risk of infection among the prostate cancer patients on ADT.”
The analysis suggests the potential for temporary ADT use in men who are at high risk of developing COVID-19, or in those who have become infected in order to reduce severity.
Alimonti concluded: “I hope that our findings inspire other clinicians to carry out clinical trials using transient ADT in men infected with COVID-19, in addition to other experimental therapies. Although these data need to be further validated in additional large cohorts of patients with COVID-19, they provide an answer to the hypothesis that androgen levels can facilitate coronavirus infections and increase the severity of symptoms, as has been seen in male patients.”