Recent studies by JAMA (news.cancerconnect.com/pros... indicate that Alzheimer's and Dementia risk can be increased by up to 28% with ADT......as if there weren't already enough negatives....
The article also suggests that the risk can be mitigated by taking Viagra, would this interfere with the positive effects of ADT?
Has anybody tried this or have any further information? Too late for me as I'm just coming up to my 20th month of ADT!
Oh Lordy - as if we weren't having enough FUN with side effects
I have been on ADT for 8 years ...
All my life I have claimed: I'm crazy, not stoopid .
now will I have to change it to: I'm demented not stoopid
Ain't it all just one laugh after another
Hang in there men - no one ever promised it was going to be easy
and the beat goes on
PJD
I've pressed the like button again because I can't remember if I did it this morning 🙃
I wonder if substituting ADT for the transdermal E2 patch would mitigate that? I suspect it would as brain fog is supposed to be reduced with estradiol.
Anyone any ideas on that?
Estradiol is a vasodilator and is given in the ER to reduce brain swelling due to traumatic brain injury. Maybe a vasodilator would help improve brain health, in general?
I was Gleason 9, and chose Tulsa Pro Ultrasound, December 2020. About 1.5 years ago PSA started rising went to 7 from as low as 1.5 after Tulsa. They wanted to put me on ADT and plan for radiation. I told my urologist that I believe I had a UTI. He tested my urine and felt that there might be an infection but did not feel it caused my PSA rise. Also, I had bad bph (prostate was 4 times normal size before Tulsa). I went on antibiotics at my request. 30 days later PSA was 4. They still insisted I needed ADT. I chose to take bicalutamide plus dutasteride. 3 months later PSA was .7 and 30 days later .3. No fog, no ED, etc. This was the drugs of choice before ADT. Good luck.
in my case , adding transdermal estrogen to my ADT. ( both at same time, not instead of ) has not lessened my brain fog. Aggravated it if anything. Once again , I respond to medications - treatments differently than most people , so that has to be considered as well.
❤️❤️❤️
"Recent studies by JAMA (news.cancerconnect.com/pros... indicate that Alzheimer's and Dementia risk can be increased by up to 28% with ADT......as if there weren't already enough negatives...."
No they don't. Association is not causation.
Smoking and cancer?
I have never seen anything about smoking and prostate cancer.
Hi TA, How’s about drinking wines and cancer?
I noticed a lot of media hype about alcohol and cancer, but honestly, haven't looked into it. Is there Level or even Level 2 evidence?
Mine doesn't smoke, it's more of a water pistol 😉. I don't think that's by association 🙂
Omg …… bwhhaaaaaaaaa
Maybe its " causation " due to a full bladder and the problem holding your water, but not associated with prostate cancer 🤔. What do you reckon K ? All the best buddy 👍
if you are in the cohort that gets associated cardiovascular issues or associated dementia, do you care whether or not the actual causal chain is documented in humans yet?
Yes, of course one cares if adt causes dementia or if there is,say, a genetic cause of both PCa and dementia. If there is no causal link, there is no benefit in stopping adt.
do all side effects listed for drugs have known causes? more than one study notices the association and another finds a possible mechanism in animal studies for the dementia part.
Most of us don't go around making up clinical causes and don't act onour imaginary causes. Lab tests in mice have no clinical application.
so in your view the developing results showing a statistical association between adt and cardiac plus dementia issues should be completely discounted until a future correctly set up RCT provides causal evidence (really, cant see how that can ever happen as it means denying a known helpful drug to some patients).
Nobody contemplating adt should take this link into account because it is “‘made up”,. Is that a correct paraphrase?
You are imagining a causal connection between ADT and dementia. It is dangerous to act on figments of your imagination.
The study was designed to analyse the association between ADT exposure and a subsequent diagnosis of Alzheimer disease or dementia among elderly men with prostate cancer, and included 154,089 subjects, average age 74.
If there is no scientific explanation, there is only a correlation. It cannot be shown that the factor causes the outcome, however this how most research is initiated.
If there wre no contrary data, there might be a good case for a randomized controlled study, but there is a lot of contrary evidence (see below).
could be, but scientifically unproven.
Another study. ..".largest real-world study describing the association between Adt and the risk of dementia, including over 600 thousand prostate cancer patients. The risk of dementia was significantly higher in patients on ADT, with a 60% risk." ascopubs.org/doi/10.1200/JC...
Smoke doesn't necessarily mean fire, but it usually does. You generally don't have fire without smoke.
The metaphor doesn't work in this case, and metaphors don't make science, only imagination. Men who take ADT for PCa are different from healthy men in all kinds of ways. That's why association is not causation.
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. "
ascopubs.org/doi/full/10.12...
"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."
ascopubs.org/doi/full/10.12...
"We concluded that there was no difference in the risk of subsequent dementia between PC patients who did and those who did not receive ADT."
pmc.ncbi.nlm.nih.gov/articl...
"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."
pmc.ncbi.nlm.nih.gov/articl...
there are so many uncontrolled variables with the prostate cancer population it’s hard to get anything but association - also the levels of anxiety is a real issue that I’m sure increases all sort of other things not least just simply being drenched in cortisol for long periods of time.
When I was a student learning how to do research (too long ago to admit to) we didn’t have the computing power of today so multi-variant analysis didn’t happen so easily by punching in data as you felt fit until something came up as significant, which i worry is a bit of a risk these days.
Also its harder to be sure what’s up to date as new treatments and protocols are happening too fast for prospect trials to give meaningful results before something else changes the treatment options. I’ve often told what the SOC is only to see the studies are based on treatments that have changed - Or am I off beam here ?
RCTs get rid of uncontrolled variables. That's why they were invented.
"I’ve often told what the SOC is only to see the studies are based on treatments that have changed - Or am I off beam here ?" I don't understand. SOC is based on RCTs mostly. RCTs always test something new against the SOC for ethical reasons -- is that what you mean?
Of course RCTs are the gold standard for establishing causality, and their rigorous design helps control for many confounding factors and are of course the foundations of SOC.
My comment was only to point out they’re not without limitations—especially with prostate cancer where treatments are evolving rapidly where ling-term RCTs can struggle to keep pace with new protocols, treatments and the study populations, even when well-balanced, might not perfectly represent the broader, more diverse patient groups seen in everyday practice.
Only by way of example, factors such as prolonged cortisol exposure and stress, may have a significant clinical impact, but often are not fully captured. So I’m not querying RCTs invaluable evidence, but it’s also worth noting that by the very nature of PCa, research can sometimes lag behind the clinical realities and emerging complexities of the day to day patient care now more so than in other areas.
1. The link you provide is from 2019.
2. Although there are a number of barely relevant citations in the introduction, there is no citation for the body of the article.
3. Association rarely rises to the level of actionable information. Too many variables unaccounted for.
4. Smoking/lung cancer is one of the very, very few exceptions.
5. I would consider it just noise.
Alzheimer’s? Dementia? We can’t know if or how much ADT is responsible for causing or hastening the onset of these, this is true.
However, this is also true: Causal or not, of course ADT takes a little off the top (of the mind, that is) in nearly every man. How much varies, just like with alcohol or other recreational drug use.
It’s the same with several other things. Fat gain, insulin resistance, increased blood pressure, muscle loss, edema, muscle cramping, loss of libido, bone density loss and cardiovascular disease all are either caused by or ‘associated’ with ADT,
The degree that good health returns in ALL areas (including the brain) after ADT is stopped is one question.
The other: Whether the ADT is a fixed course or lifelong, how much can one mitigate the loss?
I will never have quite the same mental acuity I did before nearly 2 years of ADT.
This is just my experience, but it is common enough. Would I do it over again? Of course I would, for I also believe ADT a major factor in my (so far) 4 year durable remission of a stage of this disease that definitely merited the use of it.
A lot of us old guys worry about ADT side effects for good reason-it has a lot of them. However, we are obviously old- and getting older-as well. Just a wee bit of a factor that we would like to ignore and often do.
ADT is rough on the body and mind no question. It’s probably over prescribed, but that is mostly non applicable for advanced disease. It also works.
Viagra is nice, so are a host of other supplements and drugs purported to attack side effects. A few of them may make a small difference.
All of them combined can’t compare to exercise and it isn’t close.
If on ADT, plenty of cardiovascular and weight bearing exercise guarantees nothing, but it does provide the greatest possible advantage over both the disease and ALL the drug side effects.
Last sentence spot on. Nothing to lose by doing ones best best to keep fit.
I wish I would have taken all the advice to workout intensely during my radiation and ADT.
As one who believes in fitness all my life I have come to the conclusion that asking someone to exercise when they do not do that normally is almost useless. They see no value in it. So when they are diagnosed they totally depend on medical solutions.
They probably did not see the tangible benefit of exercising either before or after diagnosis and besides it is easier to not get off the couch.
In my experience I have never seen an out of shape active duty Marine. Why? They exercise even when they do not feel like they want to.It is a way of life.
I was a competitive distance runner before. Year before diagnosis I ran 1,100 miles . Surgery took me out for months and soon after I had to start ADT/radiation. Even though the info/advice was out there, repeatedly, I didn't take it. Figured it would be a piece of cake to jump back in. Was not the case. I guess I let the fatigue and hormonal changes keep me on the couch making excuses. Now that I am back to the gym, it's actually pretty difficult. I didn't think I would lose that much muscle and motivation.
What it means is that reduced blood vessel size, caused by lowered activity, fatigue, and less physical exercise, can lead to restricted blood flow in the brain and therefore more cognitive decline over time, while increased blood vessel size, caused by regular physical activity and drugs, can prevent ultimate cognitive decline as we age.
I'm 80 and have been on Lupron for 11 years with no vacation from it. Have not noticed any signs of dementia although both my mom and sister had it late in life.
I'm 88 and been on Lupron for 17 years with no vacation from it and have been showing signs of dementia lately. e.g. Today I could not remember the name of my medical insurance carrier. Had to look up the name (names/words are starting to escape me).
Good Luck, Good Health and Good Humor.
j-o-h-n
Not sure that is a sign of dementia but rather of old age. We keep adding new stuff to our brain so sometimes it takes a little longer to recall the old stuff.
Thanks for your logical concern..... But what the hell was I concerned about? Must have been an old joke. Here's one:
My grandfather was talking to a friend of his about getting a new medicine for his memory. His friend asks "Hey what's the name of that medicine" Not remembering the name my grandfather answers "what's the name of the flower?" his friend says "what! A lily?" Grandfather says "no no no. the one you put in a coat" friend says " a... Carnation?" grandfather says "no no no, the one with red color and green stem" Friend answers "ooh a rose!" grandfather yells "yes!! ROSE! ROSE! So his friend says so that's the name of the medicine?" No, Grandma's name was Rose.
Good Luck, Good Health and Good Humor.
j-o-h-n
That is NOT dementia. It is hard of hearing. Without my hearing aids sometimes I just think I hear what people say.
Wife has gotten smart over the years and now asks me “do you have your ears in” before she asks or tells me to do something. No excuses then!
Viagra relaxes the artery walls allowing blood to flow more freely. It is used for pulmonary hypertension as well as ed. Magnesium also relaxes blood vessels which is why many of us take it. Research the gut, brain axis. You will find some reading on how gut bacteria affects dementia. God bless.
Agree I take daily probiotics to help the gut bacteria. No way to know if it really works but it is my only supplement.
Research the effects of berberine on gut health, insulin sensitivity and prostate cancer.
Thanks will do!
my husband has been on adt for four years and this year a tremor developed. In a year they can diagnose Parkinson's. There is a connection between Brca2 cancer and parkinson's but Ive been concerned about the side effects lately. The oncologyst only monitors,takes notes but who treats the side effects?
Be warned that this is a difficult area to navigate and as already pointed out, association does not equal causation.
Having said that, I got interested in this area because I experienced brain dysfunction within a few months of starting ADT with ARI. Specifically I developed reduced visuo-spatial awareness - my wife and son (age 40) both kept telling me I was driving too close to parked cars and the verge and ended up clipping a parked car! And, I also had impaired cognition and attention span which resulted in financial errors . All reversed within about 4 months of stopping and I was only on therapy for less than a year.
I then read up the literature. There are observational studies suggesting an association, and some suggesting no association, but they are intrinsically problematic. However, there are direct brain studies looking at T deprivation and brain metabolism in patients. A good starting point (and reference source) is: "Changes in cerebral metabolic activity in men undergoing androgen deprivation therapy for non-metastatic prostate cancer" Prostate Cancer and Prostatic Diseases volume 21, pages394–402 (2018).
Another small controlled study (Open access) is: The impact of long-term androgen deprivation therapy on cognitive function and socioeconomic decision making in prostate cancer patients. 15 June 2020 doi.org/10.1002/pon.5442.
A critical review of this area, which highlights all the problems of studies in this area, is to be found in: "A review of prostate cancer treatment impact on the CNS and cognitive function" Prostate Cancer Prostatic Dis. 2019 Dec 16;23(2):207–219.
The bottom line is that androgen deprivation/blockade does seem to affect brain function but we cannot be certain that it causes Alzheimers/dementia. Much better studies are needed (and they will be difficult to do). For example any association may be secondary to the effects of lipid dysfunction/metabolic sydrome.
PS I would add that I feel many oncologists often seem too focussed on the the 'cancer outcome' while not giving patients enough information on the potential risks to other aspects of 'health outcome'. That balance is easier to strike in a man of 55 but gets more difficult with advancing age with the changing risk profile. Sorry if that is a bit obvious but it needs saying.
Great post!
arrrr me ship would be on the bottom if it was not for ADT
Totally understand, but should we all be taking Viagra in on ADT?
That answer for me is no. I have taken 40mg of sildendifil for ed for a short period after Covid. That is only 40% of a full strength viagra. Headaches and nasal congestion were the immediate side effects for me. I take curcumin and berberine. Much of the brain problems come from gut problems. Cdiff, IBD, and IBS have been linked to dementia as well. While I am not a fan of absolutes, I do believe it was Hippocrates said that all illness begins in the gut.
Thanks Prof, you're one of the first people to actually answer the question I posed at the beginning.....
You are quite welcome. If you research ADTs effect on gut health you will find that lack of T will cause gut dysbiosis. This is an imbalance of the gut bacteria. It can hinder response to ADT after a while by producing androgens that the cancer feed on. It can also cause a build up of undesirable matter in the brain that can lead to dimentia. There is a lab, the Karen Sfanos lab, at JHU set up solely to test gut micrombe effect on diseases, including prostate cancer. Berberine is reported to balance the gut bacteria by killing the bad and providing an environment that the good bacteria can flourish in. It also has been shown to help cure leaky gut which has also been linked to dimentia. Hope this helps. God bless.
There is also an association between the age group that contracts prostate cancer and the age group where dementia can occur, as well many other associations
There are tons of side effects.. None worse than Cancer progression. 14 years out.
The article also suggests that the risk can be mitigated by taking Viagra, would this interfere with the positive effects of ADT?
No but it might give you a headache, lower back ache, and a stuffy nose lol.
I experimented in my 40's a little bit and preferred Cialis. But of course everyone reacts differently. And in the case of this study I don't know if Cialis mechanism of action is the same as Viagra.
Common prostate cancer treatment tied to dementia, study shows
Kidney Stones after ADT
EMBARK Study: ADT vs Enzalutamide +/- ADT
