ADT and risk for COVID-19 infection?

Early in 2020, in the initial stages of the COVID-19 pandemic, there was a suggestion (based on data from a small Italian study) that men who were using androgen deprivation therapy (ADT) to manage their prostate cancer might be at lower than average risk for becoming infected with this virus. Another early but also small study from Finland failed to confirm the original Italian report. A new and much larger study now appears to have “debunked” the original hypothesis as well.

The new paper by Klein et al. (from the Cleveland Clinic), just published in the Journal of Urology, is based on data from a large institutional registry of > 74,000 patients who were tested for the COVID-19 virus between March 12 and June 10, 2020. The full text of this paper is accessible on line.

Of these patients,

  • 4,885/74,787 (6.5 percent) were positive for COVID-19
  • 1,779 men had prostate cancer
  • Of those 1,779 men
    • 304 (17 percent) were on ADT and
    • 1,475 (83 percent) were not on ADT
  • The men on ADT were generally
    • Older
    • More likely to have a history of smoking
    • More likely to have reported taking steroids (e.g., in combination with abiraterone acetate)
  • Most other factors known to increase both risk of infection and disease severity were equally distributed between the ADT and no ADT groups.

Klein et al. conclude that, based on their data:

In men with prostate cancer ADT did not protect against SARS-CoV-2 infection. These results do not confirm the experience in Northern Italy. Routine use of ADT in patients at risk for or affected by COVID-19 is not warranted in the absence of controlled clinical trials showing benefits for prevention, mitigation of disease severity or improved survival.

However, we should carefully point out that Klein et al. also state in their conclusion that:

We eagerly await the results of ongoing trials testing antiandrogen agents in various stages of this disease.

We can not, as yet, absolutely rule out the possibility that some forms of ADT may have a protective effect against COVID-19 infection in some men with or without prostate cancer. On the other hand, the original Italian suggestion now appears to be a great deal less likely than when it was first put forward.

3 Responses

  1. Wondering if PCF has responded to this study? They widely broadcast the Italian study that they had supported.

  2. PS Jonathan Simon did not comment on either this or the earlier study during his FB presentation on PCa and Covid vaccinations earlier this week . He did address ADT specifically.

  3. It is worth noting, also, that a presentation to be given by Kwon et al. at the upcoming virtual Genitourinary Cancers Symposium has also shown no relationship between treatment with ADT and reduction in risk for COVID-19 infection.

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