Androgen deprivation and SARS-CoV-2 in men with prostate cancer

Abstract: Annals of Oncology Letters to the Editor Androgen deprivation and SARS-CoV-2 in men with prostate cancer We read with great interest the very recent article by Montopoli et al.,1 which reports men with prostate cancer tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Veneto, Italy, by 1 April 2020. The authors suggest that androgen deprivation therapy (ADT) could partially protect from SARS-CoV-2 infection.1 The biological premise for this observation is the androgen receptormediated regulation of TMPRSS2,2 a type II transmembrane serine protease that is important for SARS-CoV-2 entry to host cells.3 Indeed, androgens regulate TMPRSS2 expression also in a lung carcinoma cell line.4 Encouraged by the findings of Montopoli et al.,1 we examined the health care records of patients with prostate cancer [International Classification of Diseases (ICD)-10 code C61] in the Hospital District of Helsinki and Uusimaa, Finland, using automated text mining with manual verification and structured diagnostic codes. Altogether, 352 such men were tested for SARS-CoV-2 between 7 March and 14 May 2020. A patient was classified to be on ADT if he had a history of orchiectomy, or a valid prescription for a gonadotropin-releasing hormone (GnRH) analogue, GnRH antagonist, and/or antiandrogens (flutamide, bicalutamide, enzalutamide) or the CYP17 inhibitor abiraterone before his SARS-CoV-2 test (n ¼ 134) [38%, 95% confidence interval (CI): 33%e43%]. The mean age of these 134 men was 78.4 years  8.1 standard deviation (range 58e96 years). The frequency of being on ADT was in agreement with that observed in a survey of a large cohort of UK men with prostate cancer.5 Conversely, a patient was classified not to be on ADT if no records of the above conditions were found or ADT had been ceased before a SARS-CoV-2 test (n ¼ 218; mean age 76.5 years  9.4 standard deviation, range 51e96 years). The presence of SARS-CoV-2 RNA in nasopharyngeal swab samples was analyzed by RT-PCR (details available upon request). This study was based on register data, provided by the registry holder, Helsinki University Hospital, and therefore no ethical permission was required according to the Finnish Medical Research Act. Of the 352 prostate cancer patients, 17 (4.8%, 95% CI: 2.6%e7.0%) tested positive for SARS-CoV-2, and 6 (35%, 95% CI: 13%e58%) of them were on ADT. However, the frequency of being positive for SARS-CoV-2 was not associated with ADT [6/134 on ADT versus 11/218 not on ADT; odds ratio (OR) 0.88; 95% CI 0.32e2.44, P ¼ 0.81]. ADT was not associated with the severity of the disease, as assessed by occurrence of death or the need of intensive care (1/6 in the ADT-positive group versus 3/11 in the ADT-negative group; OR 0.53; 95% CI 0.04e6.66, P ¼ 0.63). There were no differences in possible confounding comorbidities on Volume 31 - Issue 10 - 2020 Table 1. The presence of potential confounding factors on COVID-19 severity in SARS-CoV-2 tested patients with prostate cancer classified on the basis of being on androgen deprivation therapy Age > 65 years Hypertensionb Coronary artery diseasec COPDd Diabetese Cardiac arrhythmiaf Current smoker No ADT (n [ 218) On ADT (n [ 134) P valuea 191 47 30 12 17 41 17 125 30 21 8 16 30 18 0.10 0.89 0.64 1.0 0.26 0.42 0.10 The distributions of diagnoses from 2015 to 2 weeks before the SARS-CoV-2 test are shown. Smoking status was extracted by using automated text mining and manual verification. The data denote the..