Does SARS-CoV-2 Affect the Prostate? A Molecular Analysis from a Case Series of COVID-19 Patients

Abstract

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19 that has been spreading worldwide since December 2019. Viral entry into cells requires expression of both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) on the surface of the host cell. The male reproductive system, including the prostate, was supposed to be a potential target for SARS-CoV-2 since the presence of ACE and TMPRS2 receptors. This paper investigated for the first time the presence of SARS-CoV-2 mRNA in the prostatic tissue of a patient with active infection. In addition, we searched for the virus in the prostate of five patients after their recovery from COVID-19. The SARS-CoV-2 RNA was not detected in any of the prostate tissues tested even during the acute phase of infection. As case series have limitations, causality cannot be excluded and sporadic evidence of prostatic tissue invasion by SARS-CoV-2 may be detectable.

Keywords: COVID-19; Genitalia, male; Prostate; Real-time polymerase chain reaction; SARS-CoV-2.

Fig. 1. Graphical representation of real-time quantitative polymerase chain reaction (qPCR) data in negative control (nuclease-free water) (A), positive control (a plasmid containing SARS-CoV-2 target sequences) (B), and prostate samples #1 to #6 (C–H). In each panel the relative fluorescence units (RFUs) levels for qPCR reactions are plotted against the PCR cycle number. For controls and all samples, the quantification cycles (Cq) for the three target genes run in duplicate are shown. In plots the yellow line refers to ORF1ab, the red line to N gene, and the pink line to RNAse P. The negative and positive controls were valid and acceptable: in negative control the Cq for each target was undetermined; in positive control Cq_N, Cq_ORF1ab, Cq_{RNAse P} were <32. The SARS-CoV-2 RNA was not detected in any of the samples tested (C–H): Cq_N and Cq_ORF1ab were undetermined, Cq_{RNAse P} was <27.

Fig. 2. Box-and-whisker plot showing the PSA values before (pre-COVID-19) and after (post-COVID-19) COVID-19 disease. PSA: prostate specific antigen.