Department of Urology, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden.
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Prostate. 2023 May;83(6):555-562. doi: 10.1002/pros.24485. Epub 2023 Jan 19.
Androgens may play a role in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and host responses as the virus is dependent on the androgen-regulated protein transmembrane serine protease 2 for cell entry. Studies have indicated that prostate cancer patients receiving androgen deprivation therapy (ADT) are at reduced risk of SARS-CoV-2 infection and serious complications compared with patients without ADT, but data are inconsistent.
A total of 655 prostate cancer patients who were under surveillance at two urology departments in Sweden on April 1, 2020 were included in the study as well as 240 patients with benign prostatic hyperplasia (BPH). At follow-up early in 2021, the participants completed a questionnaire containing information about symptoms compatible with coronavirus disease 2019 (COVID-19). Blood samples were also collected for the assessment of SARS-CoV-2 IgG antibodies (SARS-CoV-2 Total; Siemens). We used multivariable logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ADT and the risk of SARS-CoV-2 infection.
The cumulative incidence of SARS-CoV-2 seropositivity was 13.4% among patients receiving ADT and 10.4% among patients without ADT. After adjusting for potential confounders, we observed no differences in symptoms or risk of SARS-CoV-2 infection between patients with and without ADT (OR: 0.98; 95% CI: 0.52-1.85). Higher body mass index, Type 1 diabetes, and prostate cancer severity, defined by high Gleason score (8-10; OR: 2.06; 95% CI: 1.04-4.09) or elevated levels of prostate-specific antigen (>20 µg/l; OR: 2.15; 95% CI: 1.13-4.07) were associated with increased risk of SARS-CoV-2 infection. Overall, the risk of SARS-CoV-2 infection was not higher among men with prostate cancer than among men with BPH.
Our results do not support the hypothesis that ADT use in prostate cancer patients reduces the risk or symptom severity of SARS-CoV-2 infection or that prostate cancer patients are at increased risk of COVID-19 compared with men without prostate cancer.
雄激素可能在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和宿主反应中发挥作用，因为该病毒依赖于雄激素调节的跨膜丝氨酸蛋白酶 2 进入细胞。研究表明，与未接受雄激素剥夺治疗（ADT）的患者相比，接受 ADT 的前列腺癌患者感染 SARS-CoV-2 以及出现严重并发症的风险降低，但数据并不一致。
本研究共纳入 2020 年 4 月 1 日在瑞典两家泌尿科就诊的 655 例前列腺癌患者和 240 例良性前列腺增生（BPH）患者。2021 年初随访时，参与者完成了一份包含与 2019 年冠状病毒病（COVID-19）症状相符的信息的问卷。还采集了血液样本，用于评估 SARS-CoV-2 IgG 抗体（SARS-CoV-2 Total；西门子）。我们使用多变量逻辑回归模型计算 ADT 与 SARS-CoV-2 感染风险之间的比值比（OR）和 95%置信区间（CI）。
接受 ADT 的患者中 SARS-CoV-2 血清阳性的累积发生率为 13.4%，未接受 ADT 的患者为 10.4%。在调整了潜在混杂因素后，我们观察到接受 ADT 与未接受 ADT 的患者在症状或 SARS-CoV-2 感染风险方面没有差异（OR：0.98；95%CI：0.52-1.85）。较高的体重指数、1 型糖尿病和前列腺癌严重程度（高 Gleason 评分[8-10]；OR：2.06；95%CI：1.04-4.09）或前列腺特异性抗原升高[>20μg/l；OR：2.15；95%CI：1.13-4.07]与 SARS-CoV-2 感染风险增加相关。总体而言，前列腺癌患者感染 SARS-CoV-2 的风险并不高于 BPH 患者。
我们的研究结果不支持 ADT 可降低前列腺癌患者 SARS-CoV-2 感染风险或严重程度，或与无前列腺癌的男性相比，前列腺癌患者患 COVID-19 的风险增加的假说。
