Impacts of androgen deprivation therapy on the risks and outcomes of SARS-CoV-2 infection in patients with prostate cancer

Abstract

Studies have investigated the effects of androgen deprivation therapy (ADT) use on the incidence and clinical outcomes of coronavirus disease 2019 (COVID-19); however, the results have been inconsistent. We searched the PubMed, Medline, Cochrane, Scopus, and Web of Science databases from inception to March 2022; 13 studies covering 84 003 prostate cancer (PCa) patients with or without ADT met the eligibility criteria and were included in the meta-analysis. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CIs) to explore the association between ADT use and the infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and severity of COVID-19. After synthesizing the evidence, the pooled RR in the SARS-CoV-2 positive group was equal to 1.17, and the SARS-CoV-2 positive risk in PCa patients using ADT was not significantly different from that in those not using ADT (P = 0.544). Moreover, no significant results concerning the beneficial effect of ADT on the rate of intensive care unit admission (RR = 1.04, P = 0.872) or death risk (RR = 1.23, P = 0.53) were found. However, PCa patients with a history of ADT use had a markedly higher COVID-19 hospitalization rate (RR = 1.31, P = 0.015) than those with no history of ADT use. These findings indicate that ADT use by PCa patients is associated with a high risk of hospitalization during infection with SARS-CoV-2. A large number of high quality studies are needed to confirm these results.

Keywords: androgen deprivation therapy; coronavirus disease 2019; meta-analysis; prostate cancer; severe acute respiratory syndrome coronavirus 2.

Figure 1

The PRISMA flowchart of the systematic review and meta-analysis. RR: risk ratio; CI: confidence interval; ADT: androgen deprivation therapy; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; ICU: intensive care unit; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

The correlation between androgen deprivation therapy and SARS-CoV-2 positive risk was illustrated by (a) leave-one-out sensitivity analysis and (b) a forest plot. The best models were applied to estimate each meta-analysis. For the forest plot, the line perpendicular to the X-axis indicates an RR equal to 1 (baseline). The RR values and 95% CIs of individual studies are represented by each enclosed circle and horizontal line parallel to the X-axis, respectively. Overlap between the baseline and a diamond indicates no statistical significance. CI: confidence interval; RR: risk ratio; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Figure 3

The correlation between androgen deprivation therapy and the rate of COVID-19 hospitalization was analyzed by (a) leave-one-out sensitivity analysis and (b) forest plot. CI: confidence interval; RR: risk ratio; COVID-19: coronavirus disease 2019.

Figure 4

The correlation between androgen deprivation therapy and the rate of COVID-19 ICU admission was shown in (a) leave-one-out sensitivity analysis and (b) forest plot. CI: confidence interval; RR: risk ratio; COVID-19: coronavirus disease 2019; ICU: intensive care unit.

Figure 5

The correlation between androgen deprivation therapy and the death risk of COVID-19 was illustrated by (a) leave-one-out sensitivity analysis and (b) forest plot. CI: confidence interval; RR: risk ratio; COVID-19: coronavirus disease 2019.