Recent reports have highlighted the morbidity of androgen-deprivation therapy (ADT). However, the extent of association between ADT and declines in cognitive function remains largely unknown. The authors of this prospective study included men with prostate cancer receiving and not receiving ADT, and matched controls, to evaluate the effect on patient-reported cognitive function after 1 year of ADT. They failed to identify any association between 1 year of ADT use and decline in cognitive function.
These data suggest that there is no relationship between short-term ADT use and cognitive decline among older men with nonmetastatic prostate cancer. Whether a link exists with longer-term exposure to ADT, or if there are specific subgroups at particular risk for cognitive decline, remains unknown.
– Matthew J. Resnick, MD
Written by
tango65
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That's not what the study says at all. The last sentence of the abstract states
"Twelve months of ADT was not associated with self-reported cognitive function in older men with non-metastatic PC." (bold empahsis added.)
The test used in the study, FACT-COG, asks the patients to rate how often things happen, for example "I have had to work harder than usual to keep track of what I was doing."
But if the patient is cognitively impaired, they may not recognize it! Mental illness is like that, the patient is often the last to know.
Further, men are notorious liars about subjects like these, and often deny to themselves even obvious symptoms. The canard about men never stopping to ask for directions has a kernel of truth, and also implicates one kind of cognitive processing.
Even the brief part of the study visible to the public (most is behind a paywall) admits that
"The relationship between self-reported and objective cognitive measures was weak (maximum Spearman correlation coefficient of 0.14) and only two of 30 correlations were statistically significant."
Translation: Self reporting via that FACT-COG questionaire does a lousy job of measuring cognitive function. The relationship between FACT-COG results and objective tests is "weak." The Spearman correlation value of 0.14, is very, very low - and that was the maximum!
Here's a study, N=1, non-blind, no placebo.
Taking 3 online cognitive function tests, before ADT the patient scored 85th percentile or above in all areas, and 99th percentile overall.
After 3 months of ADT, the same patient taking the same battery of tests scored 20th to 40th percentile in all but one test, 70th percentile in that one. Overall score was 35th percentile.
Distressed by this outcome, after 5 months the patient refused further ADT. Five weeks after testosterone levels returned to normal range, the same battery of tests produced the pre-ADT results: 85th percentile or above in all areas, and 99th percentile overall.
Discussing these results with several other patients on long-term ADT, several additional patients with severe cognitive impairment self-identified. All shared the common characteristic that their work required high cognitive function. ADT was associated with reduced output or complete inability to continue work. These men were forced to confront their impairment.
There are many ways to interpret these results, but sweeping statements that ADT does not impair cognitive function are not supported by this study. At best, this study shows that many men on ADT do not recognize or do not object to cognitive impairment. The results of the N=1 experience provide compelling evidence for strong cognitive effects in some men.
One year is NOTHING. There are trade-offs with all treatments. I'm Stage IV and have been on various ADT treatments almost continuously (especially Lupron) since 2004. On the one hand, I'm still alive. On the other, I can't remember plots of books or movies after a few weeks, and I frequently forget names of friends. I'm not that old (69). For me, ADT and cognitive decline is real and has had a major impact on my quality of life.
• in reply to
I’m with you there. Only 3yrs in. Something to look forward to.. happy to be alive also.. at 57..
Thanks for tango65, I followed the source to the quote by Matthew J. Resnick, MD. He's a former editor of the journal Urology.
I am dismayed but not surprised to see Dr. Resnick grossly mischaracterize this study.
"These data suggest that there is no relationship between short-term ADT use and cognitive decline among older men with nonmetastatic prostate cancer."
That is a huge, completely unjustified leap beyond what the authors of the study say. While I only have the abstract, the authors (and not Dr. Resnick) clearly state that only self assessed cognitive decline is not affected. They go on to say that there is poor correlation between self-assessed cognitive function and objective measures. In other words, self assessed tests don't work very well at all.
As Steve_McL states, one year is not typical of ADT use. Every man I have spoken to, without exception, bemoans the effects of ADT on their memory, concentration, and ability to work. That's in addition to deleterious effects on libido, hot flashes, ambition, desire (for anything, not just sex), depression, insomnia, and much more.
Resnick's mischaracterization is all the more inexcusable as an editor of a major journal. To do that job well requires a very high degree of critical thinking, willingness to challenge any result, constant questioning of data and methods. He did none of that here.
Sadly, this type of sloppy thinking is all too common among urologists, at least in my experience. Many, perhaps most urologists are dismissive of patient's complaints about the many toxicities of ADT. The abstract to this article does not support that attitude, but Resnick's gross mischaracterization is exactly what most uros will remember and repeat to their patients.
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