Science Continues to Unfold Around ADT, Prostate Cancer, and COVID-19
Last May, we reported on a study from Italy showing that men with prostate cancer were who were taking androgen deprivation therapy (ADT) were 4 times less likely to be infected with SARS-CoV-2 than men who were not on ADT and 5 times less likely to die. Other growing evidence also supported the relationship between male hormones (androgens) and the protein TMPRSS2, which plays a role in more than half of all prostate cancers AND also happens to be the protein that the coronavirus uses to enter lung cells.
Put simply, one explanation is that reducing a man’s testosterone level with ADT would decrease the amount of TMPRSS2 on lung cells, lowering his risk of infection with the virus.
Now, a new study by PCF-funded investigators Eric Klein, MD, and Nima Sharifi, MD, at the Cleveland Clinic reports that among men with prostate cancer, being on ADT did not reduce risk of infection with SARS-CoV-2. The team studied nearly 1,800 men with prostate cancer, 300 of whom were on ADT. The rates of positive coronavirus test were essentially the same among men on ADT (5.6%) vs men not on ADT (5.8%). The researchers accounted for differences between the groups in age, smoking status, and other factors, and concluded that ADT does not appear dramatically protective against SARS-CoV-2 infection in the United States.
With two studies showing apparently conflicting results, what are men with prostate cancer to do? Or even men without prostate cancer who are concerned about their risk of COVID, and might want to protect themselves proactively? Perhaps the reassuring answer is….nothing just yet. Doctors do not make health recommendations based on two observational studies, i.e., research that looks at populations rather than testing possible treatments in people. The studies are pieces of a huge and complex puzzle, gradually adding to the body of knowledge. Research continues in labs and in clinical trials, including trials of ADT to prevent severe COVID and other medicines that act on TMPRSS2. In the meantime, guidelines note that ADT does have a role in prostate cancer care during the pandemic; for example, it can be considered as part of a strategy to safely delay radiation therapy for 4-6 months in some patients. One thing we’ve learned about COVID is that there is more to keep learning about COVID. As we learn it, we’ll share it with you.
Find out more about how COVID may affect your care in the online appendix to the PCF Prostate Cancer Patient Guide, and watch our most recent Facebook Live with our CEO and medical oncologist Dr. Jonathan Simons.