What do prostate cancer and COVID-19 have in common? testosterone. How did the researchers arrive at the hypothesis that antiandrogen-based treatment might be a possible way to prevent COVID-19?
Coronavirus Male Fertility
Men with prostate cancer treated with anti-androgens, a hormone therapy that lowers testosterone levels, are less likely to catch the new coronavirus and develop a severe form of the disease, according to a study published in the Annals of Oncology monthly publication of the European Society of Medical Oncology (ESMO). It is the first to suggest a link between this treatment and COVID-19.
The researchers “put forward the hypothesis” that anti-androgenic treatments could partially protect prostate cancer patients from the new coronavirus. Cancer patients have an increased risk of becoming infected and developing severe forms of COVID-19, they point out.
Their hypothesis is based on recent research that a protein called TMPRSS2 helps the virus to infect human cells. The levels of this protein are under the control of androgens in the prostate, but also in the lungs.
An explanation for more severe forms of COVID-19 in humans
This could explain why men infected with the new coronavirus develop a more aggressive form of the disease than women, according to Professor Andrea Alimonti of the Università della Svizzera Italiana (Bellinzona, Switzerland). Of the 4,532 men in the Italian region of Veneto who were infected with the new coronavirus, 9.5% had cancer, and 2.6% had prostate cancer.
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Male cancer patients had a 1.8 times higher risk of infection than the general male population and developed a more severe disease. However, of all prostate cancer cases in this particular affected area, only four of the 5,273 men who received anti-androgen treatment developed an infection, and none died.
According to Prof. Alimonti, the risk of developing an infection was four times lower in these patients than in those who did not receive anti-androgen therapy. The risk of developing a serious form of COVID-19 was five times lower in men with prostate cancer taking anti-androgen drugs compared to any other type of cancer.
Anti-cancer treatment as prevention?
The researchers, therefore, referred to the possibility of a limited (e.g., one-month) use of anti-androgens, the effect of which is reversible, to prevent Covid-19 infection in men.
One effect of hormone therapy in prostate cancer is impotence, notes Professor Fabrice André, Research Director at the Institut Gustave Roussy (IGR, France), who advises against its use before clinical studies confirm its efficacy. According to this oncologist, editor-in-chief of the Oncology Annals, this study provides a reason to evaluate the efficacy of treatment against COVID-19, “but does not allow conclusions to be drawn about its role in patients infected with the coronavirus.”
Several studies around the world on patients with cancer are ongoing and should soon come up with a conclusion on this hypothesis.
References
Montopoli, M., Zumerle, S., Vettor, R., Rugge, M., Zorzi, M., Catapano, C. V., Carbone, G. M., Cavalli, A., Pagano, F., Ragazzi, E., Prayer-Galetti, T., & Alimonti, A. (2020). Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: A population-based study (N = 4532). Annals of Oncology, 31(8), 1040–1045. https://doi.org/10.1016/j.annonc.2020.04.479
