Clinical Scorecard: Link Between SARS-CoV-2 Infection and Severity of Disease in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• Male patients have approximately three times higher COVID-19 severity and progression rates compared to females, potentially due to androgen-regulated enzymes facilitating viral entry.
• ADT and second-generation androgen receptor targeting therapies suppress androgen-activated pathways implicated in tumor progression and may influence COVID-19 severity.
• Systematic review and meta-analysis conducted to assess whether ADT affects risk of SARS-CoV-2 infection and severity of COVID-19 in prostate cancer patients.

Guideline-Based Recommendations

Diagnosis

• Assess SARS-CoV-2 infection status in prostate cancer patients, especially those undergoing ADT.
• Consider severity outcomes including ICU admission, intubation, and COVID-19 mortality.

Management

• Evaluate the potential protective or risk-modifying effects of ADT on COVID-19 severity in prostate cancer patients.
• Continue ADT as per oncologic indications while monitoring COVID-19 status.

Monitoring & Follow-up

• Monitor prostate cancer patients on ADT for SARS-CoV-2 infection and progression to severe COVID-19.
• Adjust clinical management based on infection severity and patient comorbidities.

Risks

• Potential increased expression of TMPRSS2 due to androgens may facilitate SARS-CoV-2 entry and worsen COVID-19 outcomes.
• Confounding factors such as age, ischemic heart disease, hypertension, diabetes, COPD, and smoking status should be considered in risk assessment.

Patient & Prescribing Data

Prostate cancer patients receiving androgen deprivation therapy (including GnRH agonists/antagonists and oral antiandrogens)

Current evidence is being aggregated to determine if ADT reduces risk or severity of SARS-CoV-2 infection; ongoing trials are evaluating androgen suppression as a therapeutic strategy in COVID-19.

Clinical Best Practices

• Use systematic screening and data extraction methods to evaluate SARS-CoV-2 infection risk and severity in prostate cancer patients on ADT.
• Adjust analyses for confounding variables such as age and comorbidities to accurately assess ADT impact.
• Employ validated quality assessment tools (e.g., Newcastle–Ottawa Scale, AHRQ criteria) for included studies.
• Interpret meta-analysis results considering study heterogeneity and use appropriate statistical models (fixed or random effects).

References

• PRISMA Guidelines
• Cochrane Consumers and Communication Review Group’s data extraction template
• Newcastle–Ottawa Scale
• Agency for Healthcare Research and Quality (AHRQ)