Incidence and outcomes of severe acute respiratory syndrome coronavirus 2 infection in patients with metastatic castration-resistant prostate cancer

Abstract

Background Patients with cancer are at increased risk of complicated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but it is still unclear if the risk of mortality is influenced by cancer type or ongoing anti-cancer treatments. An interesting debate concerning the potential relationship between androgen deprivation therapy (ADT) and SARS-CoV-2 infection has recently been opened in the case of prostate cancer (PC), and the aim of this multi-centre cohort study was to investigate the incidence and outcomes of SARS-CoV-2 infection in patients with metastatic castration-resistant prostrate cancer (mCRPC). Patients and methods We retrospectively reviewed the clinical records of patients with mCRPC who developed SARS-CoV-2 infection, and recorded their baseline clinical characteristics, their history of PC and SARS-CoV-2 infection, and their oncological status and treatment at the time of infection. The primary study end point was the death rate and the possible impact of the patients' PC-related history and treatments on mortality. Results Thirty-four of the 1433 patients with mCRPC attending the participating centres (2.3%) developed SARS-CoV-2 infection, 22 (64.7%) of whom were hospitalised. Most of the patients were symptomatic, the most frequent symptoms being fever (70.6%), dyspnoea (61.8%), cough (52.9%) and fatigue (38.2%). After a median follow-up of 21 days (interquartile range: 13–41), 13 patients had died (38.2%), 17 recovered (50.0%) and four (11.7%) were still infected. The number of treatments previously administered for mCRPC had a significant impact on mortality (p = 0.004). Conclusions Our findings contribute additional data to the current debate concerning the postulated protective role of ADT, which seems to be less in patients with metastatic PC.

Increased Hospitalization and Mortality from COVID-19 in Prostate Cancer Patients

“…Of these five studies, only two studies provided information on the hospitalization and mortality rates in COVID-19-positive PCa patients and were used for analysis ( Figure 8 ). These two studies reported a higher incidence of hospitalization and mortality in COVID-19-positive PCa patients, similar to our study [ 12 , 15 ] ( Figure 8 ). Studies used for comparisons, presented in Figure 7 and Figure 8 , include data from the Turkish National Registry Data [ 21 ], COVID-19 and Cancer Consortium (CCC19) Database [ 14 ], Detroit study [ 17 ], a single-center retrospective study from New York City [ 22 ], and data from Veneto hospitals in Italy [ 15 ].…”

“…A PubMed search of “prostate cancer” and “COVID-19” resulted in nine studies [ 2 , 12 , 13 , 14 , 15 , 16 , 17 , 21 , 22 ]. After reviewing the nine publications, which did include relevant information on the incidence of COVID-19 in prostate cancer patients, we excluded four studies [ 2 , 12 , 13 , 16 ] that did not include details of the reference group in their analysis. The five studies that were selected reported the incidence rate of COVID-19 in patients with prostate and other genitourinary cancer ( Figure 7 ).…”

“…Androgen, and androgen receptor signaling, a hallmark of prostate cancer, can augment COVID-19 severity due to its ability to enhance the expression of type II protease, TMPRSS2 [ 4 , 5 , 6 , 7 , 8 , 9 ], a central molecule that mediates severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and by dampening the innate and adaptive immune responses [ 3 , 10 , 11 ]. Several studies that have focused on evaluating the severity of COVID-19 in prostate cancer patients demonstrate that the interaction between COVID-19 and prostate cancer results in an unfavorable clinical outcome [ 2 , 12 , 13 , 14 , 15 , 16 , 17 ]. Furthermore, studies also show the anti-androgens protective effect in decreasing COVID-19 pathogenesis [ 15 ].…”

Association between SARS-CoV-2 infection and disease severity among prostate cancer patients on androgen deprivation therapy: a systematic review and meta-analysis

“…1. After applying the inclusion and exclusion criteria six studies (Patel et al updated their study in 2021 [18,21]) were included for systematic review; Caffo et al was excluded from the meta-analysis due to the lack of a control group [22].…”

Management Recommendations for Prostate Cancer during the COVID-19 pandemic: A Systematic Review

“…No PCa risk or stage was specified, but the authors concluded that PCa patients on ADT have a significantly lower risk of COVID-19 infection (OR 4.05; 95% CI 1.55 to 10.59). Caffo et al [45] performed a multicenter retrospective study in Italy (20 oncological centers), including 1433 men with metastatic castration-resistant PCa (mCRPC), who continued oncological consultation during the pandemic (February to June 2020); 34 (2.3%) developed SARS-CoV-2 infection, all of them with ADT, 9 with concomitant chemotherapy, and 19 with concomitant androgen-receptor-axis-targeted therapies (ARAT). Thirteen patients (38.2%) died, 85.7% of whom had previously received 2 or more mCRPC therapies.…”