The following article features coverage from the American Urological Association (AUA) 2021 annual meeting.
by Colby Stong
Cumulative androgen deprivation therapy (ADT) exposure after prostate cancer treatment is associated with the onset of dementia, according to data presented at American Urological Association (AUA) 2021 Virtual Experience.
The retrospective analysis included men aged 50 years and older with prostate cancer from the University of California, San Francisco Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a nationwide, longitudinal observational study that includes 43 primarily community-based urology practices in the United States. The primary outcome was the onset of dementia after prostate cancer treatment.
ADT exposure was expressed as a time-varying independent variable of total ADT exposure throughout the follow-up period. Patients with dementia were identified with use of International Classification of Diseases, 9th revision/Common Procedural Terminology codes.
The probability of receiving ADT was estimated with the use of a propensity score, and Cox proportional hazards regression was conducted to assess the association between ADT exposure and dementia with competing risk of death, adjusted for propensity score and clinical covariates.
A total of 13,570 men were included, of whom 317 (2.0%) were diagnosed with dementia after a median follow-up of 7.0 years (interquartile range [IQR], 3.0-12.0). Cumulative ADT exposure was significantly associated with dementia compared with no ADT exposure (hazard ratio [HR], 2.02; 95% CI, 1.40-2.91; P <.01).
In a subset of 8506 men who were propensity score–matched by whether they had received any ADT, the association between ADT use and dementia (HR, 1.59; 95% CI, 1.03-2.44; P =.04) remained significant. The primary treatment type was not associated with dementia onset among the 8489 men who did not receive ADT.
“This increased risk [of dementia] should be accompanied by a careful and complete discussion of the needs and benefits of ADT in those being considered for such treatment,” the researchers commented.
Reference
Lonergan PE, Washington SL, Zhao S, et al. Cumulative androgen deprivation therapy exposure after treatment for prostate cancer is associated with an increased risk of dementia. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. MP24-06.
Before anyone takes the leap to concluding that ADT causes dementia from yet another retrospective observational study, one should ask oneself if there is obvious "selection bias" that accounts for the association. There is. Men who don't take ADT for their diagnosed prostate cancer generally don't need it. Men who take ADT, generally do. So the increased observation of dementia in men who take ADT has a lot to do with the debilitating effects of advanced cancer. In studies where the degree of cancer is corrected for, no such association is found.
For example:
"In this population-based study, the use of ADT was not associated with an increased risk of dementia. "
"These data suggest that ADT treatment has no hazard for AD and no meaningful hazard for dementia among men age 67 years or older who are enrolled in Medicare."
"Our analysis of FDA MedWatch adverse event data reports does not support the idea that androgen deprivation therapy per se is associated with Alzheimer’s disease or cognitive dysfunction. Perhaps the prostate cancer itself, or the stress it imposes on the man who has it, may be detrimental to mood and intellect, increasing susceptibility to Alzheimer’s disease and cognitive disorder."
Or one of my favorite Greatjohn quotes… “it’s easy to forget how hard it is to remember “
I do believe that ADT does effect one's ability to maintain concentration. But with respect to dementia, I'm not so sure. I'm still very good with recall and learning complex systems. I'm a software developer and I constantly need to learn new technologies.
I went with orchiectomy instead of ADT due to reading numerous reports of immediate AND longer term issues. As far as Dementia -- ONLY the SHADOW KNOWS for sure.
All i know ....and all i can remember...is life b4 apc was spent not worrying if im loosing my mind...no one in my fam hist. Had dementia....slow memory is part of aging....we all agree....but the s.e. of adtare pronounced....and now the time spent fighting apc and s.e.....is not a bargain i was looking forward too....they get money for studies....the scale tips to who best served....just my honest opinion
Yes, Brain Fog, fatigue, makes one wonder if it is all worth it.
Why this community based study by Urologists; and what did it prove? Not a damn thing....... One in nine people age 65 and older (11.3%) has Alzheimer's dementia. As expected, dementia increased dramatically with age, from 5% of those aged 71 to 79 to 37.4 percent of those age 90 and older.- a far cry from the panic of 2% taking ADT. Perhaps these Urologists should read “Neuroepidemiology” before venturing out of their lane.
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