Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: March 27, 2020
Dr. Oliver Sartor, one of the leading researchers in advanced prostate cancer today, talks about what is happening in New Orleans this week and a potential link between COVID-19 and prostate cancer.
He is the Laborde Professor of Cancer Research in the Medicine and Urology Departments of the Tulane School of Medicine, the editor-in-chief of Clinical Genitourinary Cancer and the author of more than 400 scientific papers.
Dr. Sartor: In New Orleans, we're having a dramatic increase in the number of COVID-19-positive cases. In part, that's driven by increased access to testing. We now have drive-by testing and in-hospital testing. In the next 24 hours, we'll also have 24-hour testing that'll be available through a particular Roche kit. That will be nice because we can turn around results faster.
Some hospitals are starting to show real strain in their capacity. So far, we've got enough ventilators here in New Orleans, but that depends on the future curve and whether or not we can flatten the curve.
Personal protective equipment is being reused. Masks are being allocated, but we're getting more masks soon. In fact, my home institution just donated a substantial number of masks and personal protective equipment to another hospital in New Orleans because we were doing okay, and they were very short.
People are coming together in a nice way. We have a citywide consortium of intensive care beds, and they're having open forums and regular conference calls to keep up. Infectious disease experts are getting up clinical trials, including one that may have relevance to prostate cancer.
New Orleans is concerned, but people here, including young people, are taking social distancing seriously. The streets are almost empty. All of our restaurants are closed. All of our bars are closed. The hotels are empty. Hopefully we're doing the right thing as a population.
The curve here is extremely steep, and people are aware of it. We've had a number of deaths, including some deaths of relatively young people. One particular retirement home has become an epicenter, and people's parents and grandparents are being infected. People are scared here, and that fear is translating into compliance.
Other areas of the country somehow think that they're going to be immune. For instance, in the middle of Louisiana, a very large church service was held with 1,800 people crowded in a room. I cannot imagine putting myself into that position, particularly if I had a mother, aunt, or grandmother that needed to be taken care of. So yes, there are people in the country who are not doing smart things, but in New Orleans, we're ahead of the curve, both in terms of the virus but also in compliance.
One of the receptors that the virus binds to is TMPRSS2. TMPRSS2 is well known in prostate cancer circles because it is expressed in prostate cancer and is part of a translocation, the TMPRSS2-ERG translocation, or TMPRSS2-S family translocation, which occurs in about half of men. TMPRSS2 is also expressed in the lung. You may have read that there is a predilection toward male death in this disease. The infection rate doesn't seem to vary particularly, although men may have a slightly higher infection rate, but the death rate and severe COVID-19 disease rate is worse in men.
TMPRSS2 in the lung can be downregulated, or reduced or suppressed, by androgen deprivation therapy (ADT). Alexander Meisel, from the University Hospital in Zurich, brought this idea to Bayer, who has a drug called Nubeqa (darolutamide). This drug can downregulate the androgen receptor and is reversible. Bayer is going to do a clinical trial in hospitalized COVID-19 patients using Nubeqa (darolutamide)
There are other agents that could be used in this setting. Some may be as simple as Casodex (bicalutamide). This is not an endorsement for people to start taking Casodex (bicalutamide), but a clinical trial will be done on ADT. Because the TMPRSS2 is a receptor for the virus and is expressed within lung tissue, that may explain part of the male predilection for severe COVID-19 illness.
[Prostatepedia’s Note: This means that there is a chance that men on Androgen Deprivation Therapy are protected slightly from COVID-19 compared to men their age not on ADT. Clinical Trials are underway; please do not rush to ask your doctor to prescribe ADT unless you are already in treatment. This is just a hypothesis and has not been shown to be true.]
The localized prostate cancer patient is not someone who has a suppressed immune system. People with cancer are worried about a suppressed immune system, but if you've got a Gleason 6, 7, or 8 disease, localized disease, that doesn't predispose you to an immune dysfunction. If you have advanced disease with multiple metastatic lesions, or disease, that could be different.
ADT and the variety of hormonal therapies we use, including Zytiga (abiraterone), Xtandi (enzalutamide), and Nubeqa (darolutamide), are not immunosuppressive. People on those types of agents are not particularly susceptible to the virus. Based on this new hypothesis, they could even have some protection, which of course remains to be proven. It's just a hypothesis, and it may not be true. I don't want to go overboard by promising people with ADT that they're less susceptible.
Try to maintain contact with your doctor, but please be patient with your doctor, particularly if it's a non-emergent issue. We are being inundated with calls with concerns about the virus, concerns about prostate-specific antigen (PSA) testing, and concerns about upcoming scans. All the physicians in the country right now are working hard. If it's not urgent, then deferring communication for a bit is fine.
Our medical personnel is stretched thin right now. If somebody is on chemotherapy or they have particularly advanced prostate cancer, or metastatic disease, they need to be cautious. Isolation should apply to everyone right now because that's how we're going to turn this pandemic around. But it especially applies to people on chemotherapy or with advanced cancer.
Posted: Mar 27, 2020