ADT and Dementia Link Study

[Mkeman]

The relationship between ADT therapy and dementia or Alzheimer disease has been debated for quite some time. A new study presented at the urology convention last weekend suggests that patients on ADT for six months or longer might have a 25% greater risk of developing dementia and 37% greater risk of developing Alzheimer. A report on the study is on Drugs.com. This study coupled with studies that show increased risks for cardiac problems suggest to me that our MOs should arrange for basic screening for these conditions during our regular visits.

[FCoffey]

The article is here:

drugs.com/news/does-hormone...

It's a pretty strong association, with a 17% increase for any type of dementia, and a 23% increase for Alzheimer's disease. The problem appears to get worse the longer one is on ADT, with these results applying to men on ADT for 6 months or more.

Predictably, some urologists pooh-pooh the idea.

Given these findings, "physicians should be telling their patients about that risk and should probably perform regular screening," Tully said.

One urologist, however, doesn't think patients need to be told about this tenuous association.

"I don't think it's a fair discussion to have," said Dr. Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York City.

Fair to whom? The urologist or the patient?

"We really don't have a choice. Androgen-deprivation therapy is what can be offered to men with recurring or advanced prostate cancer. It's a matter of treating a deadly disease versus the risk of developing a non-life-threatening condition," Kavaler said.

"How do you ask somebody to choose between losing your mind or not treating their high-risk disease," she said. "It's a hard position to put a patient in. I wouldn't even bring it up."

Notice the complete dismissal of any quality of life concerns. Alzheimer's disease is invariably fatal. There are no treatments to stop or reverse its progression. While the patient typically lives 3-9 years, the personality is gone long before death and a drooling husk remains.

Notice also the denial of the patient's agency, their right to make their own choices about their body and treatments. Informed consent is impossible when the patient is deliberately not informed.

The uro doesn't care. She doesn't have to live with a failing, troublesome shell of a former human being. She still gets to collect her fees for office visits, even if her patient has no idea where he is, why, or who he is facing.

Yet this uro is so threatened by this finding that she won't even discuss it with her patients. She's not alone. Every uro I've met seems to live by the same creed:

"God grant other people the wisdom to let me control their lives."

[Hidden in reply to FCoffey]

😢

[Boywonder56 in reply to FCoffey]

You nailed it wimp....and i might add maybe the lady uro...has a thing about " men"....likes to see em slowly destroyed...just sayin

[de-luke in reply to Boywonder56]

Maybe Boywonder56 hates women and wants to blame attributes to women that stream from that hatred. (Do you see how unfair that kind of "just saying" argument is?)

[pjoshea13]

To understand what those percentages mean, one needs to have the base age-related risks of dementia & Alzheimer's:

nia.nih.gov/research/dbsr/a...

alzheimers.org.uk/sites/def...

Plus, one should become familiar with modifiable risk factors.

-Patrick

[FCoffey in reply to pjoshea13]

Granted. The probability of dementia goes from about 4% for those aged under 74, to about 10% for ages 75-84, and rises to 35% for ages 85+.

So the control-freak uro, facing a clear-minded 85 year old man, will neglect to tell him that her preferred treatment will raise his chance of Alzheimer's disease from 35% to 43% after 6 months, and things will probably get worse after that.

At age 85 US men's life expectancy is about 6 years. He has some hard choices about how to spend those final years - but he can choose wisely only if he is told the truth.

[dockam]

The numerous side effects (fat gain, muscle loss, depression, and cardiac problems) of ADT may be offset with exercise.

Maybe dementia also: medicalnewstoday.com/articl...

It may be that aerobics perfuse the brain with blood/oxygen and that may help stave off cognitive issues: onlinelibrary.wiley.com/doi...

Get 'er done y'all

Randy

[whatsinaname in reply to dockam]

Do mental exercises for a change instead of all the excessive brainless physical exercising.

[Hidden in reply to whatsinaname]

Pingshuai for ALL!

[garyi]

All the above just reinforce that RO's and MO's are woefully remiss in their understanding of, and open communications about, the QoL side effects of ADT.

[Magnus1964]

I have been on ADT drugs for years. I have no doubt I have lost some mental aquity but then I am 73 years old. So I would expect to lose some. I can't recall those Jeopardy questions as fast as I used to. I sit there and say I know that, just give me a minute.

[whatsinaname in reply to Magnus1964]

Everyone of us on ADT drugs loses some amount of cognitive ability.

Some more, some less. But, do not expect your quacks to tell you about it. Or, even if they do, they will play it down drastically.

Read and learn. Then decide for yourselves whether the pros outweigh the cons in taking or continuing to take ADT drugs.

[Hidden in reply to whatsinaname]

Dam quacks .

[Hidden in reply to Magnus1964]

Hahaha

[Hidden in reply to Magnus1964]

I m 58 and d9 the same . You’re doing great ..

[j-o-h-n in reply to Magnus1964]

I love multiple choice questions.....👀

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 05/10/2019 7:01 PM DST

[Hidden]

Thanks .........,I’m right there. Ive been on ADT 50 months now .. who hooo. Loss of cognition? Oh yah . This is one of the prices that the fortunate ones who make it past the first two years are willing to pay in order to be able to stick around this glorious earth for a few more years .... 😂

charms

[FCoffey in reply to Hidden]

I don't know. I make different choices. Quality of life matters more to me that quantity.

I just stopped ADT again - after 1 month. My PSA fell by a factor of 5, to a value I haven't seen in years.

What's the point of staying on ADT until it fails? I'd rather use it sparingly while it still works. Manage the cancer as a chronic disease rather than make it worse by trying to cure it. Face it, we are all going to live with disease for the rest of our lives, no matter what the PSA says. It can be zero and you'll still be living in fear of a test coming back positive.

Why put up with severe cognitive impairment? For me it is quite severe, intolerable. I live the life of the mind.

I'll watch the PSA and repeat when it climbs back up to its previous high value. Hopefully that will take months or even a year or two. In the meanwhile, I'm enjoying life, not developing castration-resistant cancer, and reducing the toxic effects such as early onset dementia and CVD.

I made it past the 2 year mark 10 years ago. No RT, no RP, no incontinence, no safety pads, no impotence, no ED. This disease sucks but I'm happy with my choices.

[j-o-h-n in reply to FCoffey]

Good choice... You inspired me to think about become a Chippendale dancer again...But I can't seem to remember the color of the rolled up socks that I used to put in my briefs... Woe is me...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 05/10/2019 7:09 PM DST

[Hidden in reply to FCoffey]

You should be happy . You ve done well .

[FCoffey in reply to Hidden]

I am happy. Thank you.

[middlejoel]

We all make choices and then we look back and see and ask, did I choose wisely? Who knows? For me its been 12 years now. After 6+ years of Watching and Waiting, I chose no RP nor Radiation to my Gleason 7 and PSA 6+, but opted for 7 months of ADT3 followed by 3 cycles of treatment consisting mostly of estrogen patches plus Avodart plus Dim, all in between times off where only Dim and Avodart where continued, I recently appeared to have reached the end of that type of treatment as the PSA nadired at 0.58. I have now stopped the patches and I am looking at future treatment. I am now 82 years old and so far, with the exception of hot flashes while on ADT3 and a couple of large boobs, my quality of life has not been much different than it would have been if I had not been afflicted with PCa.

[monte1111]

I already look pregnant. All I need is a couple of large boobs. Popped over to watch a news short and cried real big tears. And now I'm going to have dementia, but the good news is that with my Alzheimer's I won't remember it. At least with my cognitive issues I won't remember why I was sad today. Enjoy tomorrow everyone.

[Hidden in reply to monte1111]

😂

[Boywonder56]

I am at that crossroad 2yrs Lupron only.....no rp no radiation…..the rat poison Lupron works....but for me it has made qol barely livable....I want to go on adt vacation but mo says no.....my brain was ...is my greatest treasure.....the Ed....my second greatest loss...

I'd just like to wake up with a boner and remember what to do with it....

[FCoffey in reply to Boywonder56]

As my MO told me, "No one is going to hold you down and force you to take another Lupron injection." My MO is a trusted advisor. I make the decisions.

[Hidden in reply to Boywonder56]

Haha rat poison is right... Unfortunately rat don’t go away easily ,poison is sometimes needed . I’m on adt too.. no one ,especially my drs don’t want me to stop adt . No signs of pc but I’m dwindling away ... I’ve been in the mouth of T-4 APC chomping me down . I’ll take adt over APC any day .

[Boywonder56]

Dilema is im in trial and lupron is std.of care....thru trial get scans and drug....one of the deplorable uninsured...till 64 and medicare...could drop out of trial..watch p.s.a..bone scan is still cheaper than ins. And 5k deduct🤔