Is COVID-19 a Risk Factor for Progression of Benign Prostatic Hyperplasia and Exacerbation of Its Related Symptoms?: A Systematic Review

May 2021 in “ Prostate Cancer and Prostatic Diseases ”

Abdolreza Haghpanah, Fatemeh Masjedi, Mehdi Salehipour, Alireza Hosseinpour, Jamshid Roozbeh, Akram Dehghani

COVID-19 benign prostatic hyperplasia BPH SARS-CoV-2 angiotensin converting enzyme 2 ACE2 inflammation metabolic disturbances lower urinary tract symptoms LUTS androgens androgenic alopecia 5-alpha reductase inhibitors finasteride Propecia

Studysummary This review analyzes the potential mechanisms by which SARS-CoV-2 may exacerbate symptoms of benign prostatic hyperplasia and suggests a connection via ACE2 and androgen receptor pathways; it reports no new clinical results. Our plain-language summary of this paper — not a Tressless recommendation.

The systematic review, which analyzed 52 papers, suggests that COVID-19 may exacerbate symptoms and progression of benign prostatic hyperplasia (BPH). The SARS-CoV-2 virus, which causes COVID-19, may infect the prostate gland by binding to angiotensin converting enzyme 2 (ACE2), leading to inflammation and metabolic disturbances. This process could worsen lower urinary tract symptoms (LUTS) and BPH. The review also highlights the potential role of androgens, noting that COVID-19 may be androgen-mediated and that males with androgenic alopecia could be at greater risk of severe COVID-19. The document suggests that 5-alpha reductase inhibitors, such as finasteride, may reduce COVID-19 symptoms. However, the review concludes that more research is needed to confirm whether COVID-19 is a risk factor for BPH progression and symptom exacerbation.

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research 5-Alpha-Reductase Inhibitors Are Associated With Reduced Frequency of COVID-19 Symptoms in Males With Androgenetic Alopecia

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research Androgenetic Alopecia Present in the Majority of Patients Hospitalized with COVID-19: The 'Gabrin Sign'

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This study observed a high prevalence of androgenetic alopecia in patients hospitalized with severe COVID-19, with 79% of men and 42% of women affected, suggesting a potential link between androgen sensitivity and COVID-19 severity.

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This study proposes that the use of 5-alpha-reductase inhibitors for treating benign prostatic hyperplasia may contribute to poorer COVID-19 prognosis in males.

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This review found that dutasteride is more potent than finasteride as a dual receptor dihydrotestosterone blocker for treating androgenetic alopecia and shares a similar safety profile in terms of fertility, teratogenicity, neurotoxicity, and hepatotoxicity.

Protective Effects of Finasteride on the Pulmonary Immune Response in a Combined Model of Trauma-Hemorrhage and Polymicrobial Sepsis in Mice

research Protective Effects of Finasteride on the Pulmonary Immune Response in a Combined Model of Trauma-Hemorrhage and Polymicrobial Sepsis in Mice

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This study suggests that finasteride treatment may improve pulmonary immune response in mice following trauma and sepsis, indicating potential as a therapeutic option after major trauma.

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Finasteride reduces inflammation and improves immune response after trauma by altering hormone levels.

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46 citations , January 2005 in “PubMed”

This paper discusses risk factors and prevention strategies for acute urinary retention secondary to benign prostatic hyperplasia, emphasizing the role of PSA levels and the benefits of medications like finasteride and alpha-blockers, but reports no new clinical results.

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408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that dutasteride more effectively reduced serum dihydrotestosterone levels than finasteride in patients with benign prostatic hyperplasia.

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1707 citations , December 2003 in “The New England Journal of Medicine”

Combination therapy of doxazosin and finasteride safely and effectively reduces benign prostatic hyperplasia progression risk.

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In this study, significantly fewer men treated with finasteride for moderate to severe BPH symptoms experienced acute urinary retention or required subsequent BPH-related surgery compared to placebo-treated patients.