Abstract: (2021) 16:66 Duarte et al. Infectious Agents and Cancer https://doi.org/10.1186/s13027-021-00406-y Open Access RESEARCH ARTICLE Impact of androgen deprivation therapy on mortality of prostate cancer patients with COVID‑19: a propensity score‑based analysis Mateus Bringel Oliveira Duarte1,2, Frederico Leal1, Juliana Luz Passos Argenton3 and José Barreto Campello Carvalheira1* Abstract Background: Previous studies hypothesized that androgen deprivation therapy (ADT) may reduce severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infectivity. However, it is unknown whether there is an association between ADT and a higher survival in prostate cancer patients with COVID-19. Methods: We performed a retrospective analysis of prostate cancer (PC) patients hospitalized to treat COVID-19 in Brazil’s public health system. We compared patients with the active use of ADT versus those with non-active ADT, past use. We constructed propensity score models of patients in active versus non-active use of ADT. All variables were used to derive propensity score estimation in both models. In the first model we performed a pair-matched propensity score model between those under active and non-active use of ADT. To the second model we initially performed a multivariate backward elimination process to select variables to a final inverse-weight adjusted with double robust estimation model. Results: We analyzed 199 PC patients with COVID-19 that received ADT. In total, 52.3% (95/199) of our patients were less than 75 years old, 78.4% (156/199) were on active ADT, and most were using a GnRH analog (80.1%; 125/156). Most of patients were in palliative treatment (89.9%; 179/199). Also, 63.3% of our cohort died from COVID-19. Fortyeight patients under active ADT were pair matched against 48 controls (non-active ADT). All patients (199) were analyzed in the double robust model. ADT active use were not protective factor in both inverse-weight based propensity score (OR 0.70, 95% CI 0.38–1.31, P = 0.263), and pair-matched propensity score (OR 0.67, 95% CI 0.27–1.63, P = 0.374) models. We noticed a significant imbalance in the propensity score of patients in active and those in non-active ADT, with important reductions in the differences after the adjustments. Conclusions: The active use of ADT was not associated with a reduced risk of death in patients with COVID-19. Keywords: COVID-19, Androgen antagonists, Androgen receptor antagonists, Antineoplastic agents *Correspondence: jbcc@unicamp.br 1 Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil Full list of author information is available at the end of the article