COVID-19 Latest: Mount Sinai Urologists Advocate That Men With Prostate Cancer Be Screened For COVID-19 Routinely Due To Severity And Mortality Risk
Source: COVID-19 Latest Aug 08, 2020 4 years, 4 months, 2 weeks, 7 hours, 43 minutes ago
COVID-19 Latest: A team of medical researchers from the Department of Urology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York in a review paper that focuses on the two diseases (Prostrate Cancer And COVID-19) advocate that males with prostate cancer should be routinely tested for COVID-19.
Their research review was published in the journal:
Nature Communications Biology.
https://www.nature.com/articles/s42003-020-1088-9
Lead researcher Dr Dimple Chakravarty, MD, from the Tisch Cancer Institute at Mount Sinai in New York City told Thailand Medical News, "The particular vulnerability of older men to COVID-19 compels us to advocate for routine screening of SARS-CoV-2 infections in prostate cancer patients."
This call is however not in line with major cancer groups such as the
American Cancer Society and the
American Society of Clinical Oncology, who do not advise COVID-19 testing on the singular basis of a person having a cancer.
The Mount Sinai team also revealed previously unpublished data from their health system on prostate cancer and COVID-19 mortality. From March 1 to April 26, the system had 9,648 COVID-19-positive patients, of which 5238 (54.3%) were male, including 114 (2.2%) with a previous diagnosis of prostate cancer.
It was observed in this COVID cohort, the mortality rate among patients with prostate cancer (n = 27) was nearly double of that among all male patients with a malignancy (n = 43) other than prostate cancer (23.7% vs. 12.7%;
P < .01).
Some medical experts are however advising that these are "preliminary" data and "caution is warranted since confounding is likely massive."
Many also do not agree with the proposal that all patients with prostate cancer should be tested for COVID-19.
Some said that it is difficult to advocate for routine screening of otherwise asymptomatic men when early detection of viral infection is unlikely to be actionable. Indeed, as of early August 2020, robust protocols for early intervention and prevention of severe COVID-19 are not yet available.
The Mount Sinai researchers also strike a conservative note in their research findings, "The true susceptibility of prostate cancer patients to COVID-19 remains unclear at this point, despite early evidence of overlapping biology and common comorbidities."
According to the Mount Sinai team, there are sex disparities with regard to COVID-19, with men at higher risk of infection and mortality than women, also citing reports from multiple countries.
In addition, the incidence of comorbidities among COVID-19-positive patients has been found to be higher in males than females.
The authors point out that male gender and age are two main risk factors for a lethal COVID-19 infection and for prostate cancer.
The researchers also state t
hat "older age and comorbidities (hypertension, diabetes,
obesity, and smoking) that adversely affect COVID-19 are also lethal for prostate cancer."
Senior author Dr Ashutosh Tewari, MD, also of Mount Sinai explained, “There appears to be a ‘perfect storm’ of COVID-19 risk, consisting of age, race (among black men), sex, comorbidities, and cancer among many patients with prostate cancer.
As a result of being a large hospital in New York City, Mount Sinai was "the epicenter of the epicenter" in the early weeks of the pandemic.
Dr Tewari said, "There was a convergence between (the type of males) who showed up in the ICU and who showed up in my prostate cancer clinic."
He added, "I also saw first-hand that men were more likely to get infected, be hospitalized, be in an ICU, and to die.”
Dr Tewari eventually was infected himself and spent 2 weeks in the ICU before being released; his wife and daughter also contracted the virus.
The New York researchers say that there may be biological mediators of the sex differences seen with COVID-19. In their review of these, they note research suggesting that in men with prostate cancer, the use of androgen deprivation therapy (ADT) may be protective against COVID-19.
Clinical trials to further explore the link between COVID-19 and prostate cancer and ADT are underway. For example, a trial on the use of bicalutamide, an antiandrogen, among patients with COVID-19 is being conducted in Baltimore. And the US Department of Veterans Affairs launched a phase II trial for the use of the hormone suppresser degarelix (a GnRH analog that blocks luteinizing hormone and thereby reduces androgens) for COVID-19-infected male patients.
Dr Tewari said men with prostate cancer need to be "super cautious" in following CDC guidelines to avoid COVID-19 and doctors need to reach out to them via telehealth for ongoing monitoring.
The researchers advise physicians to encourage behavior change for the sake of improved health and comorbidities.
The researchers said, "Men usually don't focus on these things, so pay attention to changeable behaviors. Stop smoking. Control your blood pressure. Control your diabetes. Lose weight. We men think we are invulnerable, but this is one battle you can win by being afraid, not by being brave."
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