ADT does not lower COVID-19 risk in men with prostate cancer

Androgen-deprivation therapy (ADT) is unlikely to reduce the risk of COVID-19 infection in men with prostate cancer, according to a cohort study published in the Journal of Urology.¹

The analysis included nearly 1800 men with prostate cancer from a prospective registry of men tested for COVID-19. Using multivariable analysis, the investigators found that the risk of COVID-19 infection was the same, regardless of whether or not the patient had received ADT (odd ratio, 0.93; P = .8).

The study contradicts an Italian study published in 2020 which suggested that men with prostate cancer treated with ADT had a significantly reduced likelihood of COVID-19 infection than men not treated with ADT.²

“Androgen deprivation therapy does not appear to be protective against COVID-19 infection,” the author wrote.

Overall the study population comprised 1779 men with prostate cancer, of whom 5.7% (102 patients) tested positive for COVID-19 and 17.1% (304 patients) were receiving ADT.

Among the ADT subgroup, 5.6% of patients were COVID-19 positive. This compared to 5.8% among patients not receiving ADT.

Patient characteristics showed that men receiving ADT were more likely to have smoked (68.1% vs 59.3% among patients not receiving ADT; P .005), were older (75.5 vs 73.8 years, respectively; P = .009), and were more likely to have taken steroids (43.8% vs 23.3%, respectively; P <.001).

The researchers also noted that additional factors linked to a higher risk of COVID-19 infection/severity were equally distributed between the ADT group and those not receiving ADT. These included asthma, heart failure, immune suppressive disease, diabetes mellitus, hypertension, and coronary artery disease.

In the previously reported Italian study, use of ADT in patients with prostate cancer was associated with a significantly decreased risk of contracting COVID-19 both compared with men not receiving ADT (OR, 4.05), as well as compared with patients in the study who had any other cancer type (OR, 4.86).

The Italian researchers developed a potential explanation for this apparent “protective” effect of ADT based on TMPRSS2, an androgen regulated co-factor for COVID-19 cell entry. The investigators hypothesized that the downregulation of TMPRSS2 by ADT may protect the patient against COVID-19 infection.

However, the study published in the Journal of Urology did not corroborate this theory.

“In men with prostate cancer ADT did not protect against SARS-CoV-2 infection. These results do not confirm the experience in Northern Italy. 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. We eagerly await the results of ongoing trials testing antiandrogen agents in various stages of this disease,” the authors wrote in their conclusion.

Reference

1. 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(2):441-443. doi: 10.1097/JU.0000000000001338

2. 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. 2020;31(8):1040-1045. doi: 10.1016/j.annonc.2020.04.479