ADT & SARS-CoV-2 risk

[pjoshea13]

New U.S. study below [1].

"The study cohort consisted of 1,779 men with prostate cancer from a total tested population of 74,787, of whom 4,885 (6.5%) were positive for SARS-CoV-2. Of those with prostate cancer, 102 (5.7%) were SARS-CoV-2 positive and 304 (17.1%) were on ADT. Among those on ADT, 5.6% were positive as compared to 5.8% not on ADT. Men on ADT were slightly older (75.5 vs. 73.8 years ...), more likely to have smoked (68.1% vs. 59.3%, ...), and more likely to report taking steroids (43.8% vs. 23.3% ...)".

"ADT does not appear to be protective against SARS-CoV-2 infection."

Many here will perhaps recall the earlier Italian study that concluded that:

"Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with non-cancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2 infections." [2]

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/328...

J Urol

. 2020 Sep 8;101097JU0000000000001338. doi: 10.1097/JU.0000000000001338. Online ahead of print.

Androgen Deprivation Therapy in Men With Prostate Cancer Does Not Affect Risk of Infection With SARS-CoV-2

Eric A Klein 1 , Jianbo Li 2 , Alex Milinovich 2 , Jesse D Schold 2 , Nima Sharifi 3 , Michael W Kattan 2 , Lara Jehi 4

Affiliations collapse

Affiliations

1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland, Ohio.

2 Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio.

3 Department of Cancer Biology, Lerner Research Institute, Cleveland, Ohio.

4 Department of Neurology, Neurological Institute Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.

PMID: 32897764 DOI: 10.1097/JU.0000000000001338

Abstract

Background: TMPRSS2 is a host co-receptor for cell entry of SARS-CoV-2. One prior report suggested that use of androgen deprivation therapy (ADT), which downregulates TMPRSS2, may protect men with prostate cancer from infection.

Patients and methods: Cohort study of a prospective registry of all patients tested for SARS-CoV-2 between March 12 and June 10, 2020, with complete follow-up until disease recovery or death. The main exposure examined was the use of ADT, and the outcome measures were the rate of SARS-CoV-2 positivity and disease severity as a function of ADT use.

Results: The study cohort consisted of 1,779 men with prostate cancer from a total tested population of 74,787, of whom 4,885 (6.5%) were positive for SARS-CoV-2. Of those with prostate cancer, 102 (5.7%) were SARS-CoV-2 positive and 304 (17.1%) were on ADT. Among those on ADT, 5.6% were positive as compared to 5.8% not on ADT. Men on ADT were slightly older (75.5 vs. 73.8 years, p=.009), more likely to have smoked (68.1% vs. 59.3%, p =.005), and more likely to report taking steroids (43.8% vs. 23.3%, p < .001). Other factors known to increase both risk of infection and disease severity were equally distributed (asthma, diabetes mellitus, hypertension, coronary artery disease, heart failure, and immune suppressive disease). Multivariable analysis did not indicate a difference in infection risk for those with prostate cancer on ADT (OR 0.93, 95% CI 0.54-1.61, p = 0.8).

Conclusions: ADT does not appear to be protective against SARS-CoV-2 infection.

***

[2] pubmed.ncbi.nlm.nih.gov/323...

[noahware]

"outcome measures were the rate of SARS-CoV-2 positivity and disease severity as a function of ADT use"

I see the positivity was about the same, but am I missing mention of severity? I assume that was also about the same for both groups?

My concern is less about becoming infected w/ COVID than it is in limiting the infection and surviving it, intact, if I do become infected. Vitamin D, zinc?

It almost seems that having good immune function is important early on in the event of exposure/contagion, but that later stages of a severe infection require that immune response be dampened somewhat, so as to not overreact. So it was never clear to me what role ADT might play, so far as that goes . (AND... I guess it's STILL not clear to me!)

[pjoshea13 in reply to noahware]

Healthy young-man testosterone levels are somewhat immunosuppressive. The theory is that hunting & fighting the guys in the next village might result in injuries where a vigorous immune response might interfere with the ability to make it back home.

ADT would therefore remove that issue, plus the thymus regenerates.

-Patrick

[MateoBeach]

Thanks for ferreting this out. Good to have some evidence to clarify this issue and put to rest any complacency about protective measures for the many of us on ADT.