Abstract
PurposeAndrogen-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).MethodsWe 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 I2 statistic, respectively.ResultsSix 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).ConclusionWe 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.
Highlights
The incidence of SARS-CoV-2 infection is equal in both sexes; disease severity and progression rates are approximately three times higher in the male gender [1,2,3]
Several trials are currently evaluating androgen suppression in patients with SARS-CoV-2 infection with a focus on coronavirus disease 2019 (COVID-19) disease severity [8,9,10,11,12]. Since such associations can only be uncovered by very large datasets/cohorts, we aimed to aggregate data through systematic review and metaanalysis to assess the risk of SARS-CoV-2 infection and the severity of disease in PCa patients treated with androgen deprivation therapy (ADT)
We found a non‐significant association between the SARSCoV-2 infection and disease severity with ADT use among PCa patients
Summary
The incidence of SARS-CoV-2 infection is equal in both sexes; disease severity and progression rates are approximately three times higher in the male gender [1,2,3]. This sex-specific discrepancy can potentially be explained by the mechanism of SARS-CoV-2 entry into human host cells. Both enzymes, the transmembrane angiotensinconverting enzyme 2 (ACE2) and the transmembrane protease, serine 2 (TMPRSS2) regulate SARS-CoV-2 invasion through cell membrane [4, 5]. TMPRSS2–ERG (erythroblast-specific-related gene) gene fusion is one of the best-known aberrations in PCa [4] with overexpression detected in about 40–50% of PCa patients [7]
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