Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532)
Montopoli et al.
, Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based..
, Annals of Oncology, doi:10.1016/j.annonc.2020.04.479
Retrospective 5,273 prostate cancer patients on androgen-deprivation therapy (ADT), and 37,161 not on ADT, showing lower risk of cases with treatment.
risk of death, 95.4% lower, RR 0.05, p = 0.15, treatment 0 of 5,273 (0.0%), control 18 of 37,161 (0.0%), NNT 2064, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of severe case, 74.5% lower, RR 0.25, p = 0.01, treatment 1 of 5,273 (0.0%), control 31 of 37,161 (0.1%), NNT 1551, inverted to make RR<1 favor treatment, odds ratio converted to relative risk.
risk of case, 75.3% lower, RR 0.25, p = 0.004, treatment 4 of 5,273 (0.1%), control 114 of 37,161 (0.3%), NNT 433, inverted to make RR<1 favor treatment, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Montopoli et al., 6 May 2020, retrospective, Italy, peer-reviewed, 12 authors.
Abstract: ORIGINAL ARTICLE
Androgen-deprivation therapies for prostate cancer and risk of infection by
SARS-CoV-2: a population-based study (N [ 4532)
M. Montopoli1,2, S. Zumerle2,3, R. Vettor3, M. Rugge3,4, M. Zorzi4, C. V. Catapano5, G. M. Carbone5, A. Cavalli6, F. Pagano2,
E. Ragazzi1, T. Prayer-Galetti7 & A. Alimonti2,3,5,8*
Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova; 2VIMM e Veneto Institute of Molecular Medicine, Fondazione
per la Ricerca Biomedica Avanzata, Padova; 3Department of Medicine, Università degli Studi di Padova, Padova; 4Veneto Tumour Registry e Azienda Zero, Padova,
Italy; 5Institute of Oncology Research, Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona; 6Institute for Research in Biomedicine,
Università della Svizzera Italiana, Bellinzona, Switzerland; 7Department of Oncological and Gastroenterological Sciences e Urology Unit, Azienda Ospedaliera di
Padova, Padova, Italy; 8Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
Available online 6 May 2020
Background: Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on binding of the
viral spike (S) proteins to angiotensin-converting enzyme 2 and on S protein priming by TMPRSS2. Inhibition of
TMPRSS2 may work to block or decrease the severity of SARS-CoV-2 infections. Intriguingly, TMPRSS2 is an
androgen-regulated gene that is up-regulated in prostate cancer where it supports tumor progression and is
involved in a frequent genetic translocation with the ERG gene. First- or second-generation androgen-deprivation
therapies (ADTs) decrease the levels of TMPRSS2. Here we put forward the hypothesis that ADTs may protect
patients affected by prostate cancer from SARS-CoV-2 infections.
Materials and methods: We extracted data regarding 9280 patients (4532 males) with laboratory-conﬁrmed SARS-CoV2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the coronavirus disease
2019 (COVID-19) pandemic. The parameters used for each COVID-19-positive patient were sex, hospitalization,
admission to intensive care unit, death, tumor diagnosis, prostate cancer diagnosis, and ADT.
Results: There were evaluable 9280 SARS-CoV-2-positive patients in Veneto on 1 April 2020. Overall, males developed
more severe complications, were more frequently hospitalized, and had a worse clinical outcome than females.
Considering only the Veneto male population (2.4 million men), 0.2% and 0.3% of non-cancer and cancer patients,
respectively, tested positive for SARS-CoV-2. Comparing the total number of SARS-CoV-2-positive cases, prostate
cancer patients receiving ADT had a signiﬁcantly lower risk of SARS-CoV-2 infection compared with patients who did
not receive ADT (OR 4.05; 95% CI 1.55e10.59). A greater difference was found comparing prostate cancer patients
receiving ADT with patients with any other type of cancer (OR 4.86; 95% CI 1.88e12.56).
Conclusion: Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with noncancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2
Key words: androgen-deprivation therapy, COVID-19, prostate cancer
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