Association between SARS-CoV-2 infection and disease severity among prostate cancer patients on androgen deprivation therapy: a systematic review and meta-analysis.

Reza Sari Motlagh, Mohammad Abufaraj, Pierre I Karakiewicz, Pawel Rajwa, Keiichiro Mori, Dong-Ho Mun, Shahrokh F Shariat

Journal: World journal of urology 2022;40(4):907-914

PMID: 34477955

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Plain Language Summary

The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is equal in both sexes; however, disease severity and progression rates are approximately three times higher in the male gender. Androgen deprivation therapy (ADT) and the second-generation androgen receptor targeting therapy were developed to suppress the androgen-activated intracellular cascade that leads to tumour progression and aggressive tumour growth. The aim of this study was to assess the risk of SARS-CoV-2 infection and the severity of disease in prostate cancer (PCa) patients treated with ADT. This study is a systematic review and meta-analysis of six cohort studies. The study results show that there is not a significant association between ADT use and the severity of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) in PCa patients. However, results also show that ADT does not worsen COVID-19 risk and trajectory. Authors conclude that ADT, as a cancer treatment, might be safely administered to patients during the COVID-19 pandemic.

Abstract

PURPOSE

Androgen-regulated enzymes such as the angiotensin-converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2) are involved in the SARS-CoV-2 infection process. The expression of TMPRSS2 and its fusion gene, which are increased in the epithelium of the human prostate gland during prostate carcinogenesis, are regulated by androgens. Our goal was to assess the risk of the SARS-CoV-2 infection and the severity of the disease in PCa patients treated with androgen deprivation therapy (ADT).

METHODS

We conducted a systematic review and meta-analysis according to PRISMA guidelines. We queried PubMed and Web of Science databases on 1 July 2021. We used random- and/or fixed-effects meta-analytic models in the presence or absence of heterogeneity according to Cochrane's Q test and I statistic, respectively.

RESULTS

Six retrospective studies (n = 50,220 patients) were selected after considering inclusion and exclusion criteria for qualitative evidence synthesis. Four retrospective studies were included to assess the SARS-CoV-2 infection risk in PCa patients under ADT vs. no ADT and the summarized risk ratio (RR) was 0.8 (95% confidence intervals (CI) 0.44-1.47). Five retrospective studies were included to assess the severity of coronavirus disease 2019 (COVID-19) in PCa patients under ADT versus no ADT and the summarized RR was 1.23 (95% CI 0.9-1.68).

CONCLUSION

We found a non-significant association between the risk of SARS-CoV-2 infection and COVID-19 severity in PCa patients treated with ADT. However, our results suggest that during the COVID-19 pandemic PCa patients can safely undergo ADT as a cancer therapy without worsening COVID-19 risk and trajectory.

Address: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.; The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan.; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.; Department of Urology, Medical University of Silesia, Zabrze, Poland.; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.; Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. [email protected].; Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. [email protected].; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. [email protected].; Department of Urology, Weill Cornell Medical College, New York, NY, USA. [email protected].; Department of Urology, University of Texas Southwestern, Dallas, TX, USA. [email protected].; Second Faculty of Medicine, Department of Urology, Charles University, Prague, Czech Republic. [email protected].; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. [email protected].

DOI: 10.1007/s00345-021-03810-6

Patient Centred Factor

Mediators: Prostate cancer patients on androgen deprivation therapy

Physical Environment

Xenobiotics

Clinical Imbalances

Immune and inflammation

Nutrition Evidence Keywords

Cancer Enzymes Prostate Androgen

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https://medlineplus.gov/covid19coronavirusdisease2...

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https://assays.cancer.gov/CPTAC-438

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Full Text Sources:

https://dx.doi.org/10.1007/s00345-021-03810-6

MeSH Terms: Androgen Antagonists, Androgens, COVID-19, Humans, Male, Pandemics, Prostatic Neoplasms, Retrospective Studies, Risk Factors, SARS-CoV-2, Severity of Illness Index