Androgen deprivation therapy, comorbidity, cancer stage and mortality from COVID-19 in men with prostate cancer
Rolf Gedeborg, Lars Lindhagen, Stacy Loeb, Johan Styrke, Hans Garmo, Pär Stattin
Scandinavian Journal of Urology, doi:10.1080/21681805.2021.2019304
Background: Androgens facilitate entrance of the severe acute respiratory syndrome coronavirus 2 into respiratory epithelial cells, and male sex is associated with a higher risk of death from corona virus disease . Androgen deprivation therapy (ADT) could possibly improve COVID-19 outcomes. Methods: In a case-control study nested in the Prostate Cancer data Base Sweden (PCBaSe) RAPID 2019, we evaluated the association between ADT and COVID-19 as registered cause of death in men with prostate cancer. Each case was matched to 50 controls by region. We used conditional logistic regression to adjust for confounders and also evaluated potential impact of residual confounding. Results: We identified 474 men who died from COVID-19 in March-December 2020. In crude analyses, ADT exposure was associated with an increased risk of COVID-19 death (odds ratio [OR] 5.05, 95% CI: 4.18-6.10); however, the OR was substantially attenuated after adjustment for age, comorbidity, prostate cancer characteristics at diagnosis, recent healthcare use, and indicators of advanced cancer (adjusted OR 1.25, 95% CI: 0.95-1.65). If adjustment has accounted for at least 85% of confounding, then the true effect could be no more than a 5% reduction of the odds for COVID-19 death. Conclusions: The increased mortality from COVID-19 in men with prostate cancer treated with ADT was mainly related to high age, comorbidity, and more advanced prostate cancer. There was no evidence to support the hypothesis that ADT is associated with improved COVID-19 outcomes.
Consent to participate The requirement for informed consent was waived by the Ethical Review Authority.
Disclosure statement
Ethics approval Approved by the Swedish Ethical Review Authority: Dnr 2020-03889.
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