Dr. Huang and colleagues continued this work by presenting findings from a similar study among Taiwanese men. The objective of their study was to investigate the relationship between the use of ADT and the subsequent risk of cognitive decline in Asian men with prostate cancer.
This study included a population-based cohort of 24,464 men with newly diagnosed prostate cancer between 2000 and 2008 from the Taiwan National Health Insurance Database. After excluding patients with ADT exposure, other malignancy, and diagnosis of the outcome of interests before the index date, 17,425 prostate cancer patients were included for final analysis; patients were classified as ADT group (n=12,740) or non-ADT group (n=4,685). ADT was operationalized as (i) bilateral orchiectomy, (ii) LHRH agonist, (iii) antiandrogens, and (iv) combined androgen blockade (LHRH agonist or orchiectomy + antiandrogen). Outcomes included overall cognitive decline, Parkinson’s disease and dementia. Dementia was operationalized as Alzheimer’s disease and non-Alzheimer’s disease, and all of these outcomes were confirmed on at least three validated psychological visits. A time-dependent exposure model was used, which allowed the authors to calculate the exposure period from the different usage of various kinds of ADT. A multivariable Cox proportional hazard model with time-dependent covariates was used to estimate adjusted hazard ratios of cognitive decline associated with ADT treatment modality.
The mean follow-up for these patients was 5 years. Cognitive decline was present among 794 ADT users (16 per 1000 person-years) and 271 non-ADT users (7.5 per 1000 person years). Dr. Huang and colleagues found a statistically significant association between ADT use and risk of overall cognitive decline (HR 1.51, 95%CI 1.31-1.74). Furthermore, ADT users had a 1.83-fold higher risk of Parkinson’s disease (HR 1.83, 95%CI 1.44-2.34) and 1.38-fold risk of dementia (HR 1.38, 95%CI 1.17-1.63). After further investigating the subtypes of dementia, non-Alzheimer's dementia rather than Alzheimer’s dementia demonstrated a significant higher association with ADT use. Anti-androgen use alone was also associated with subsequent Alzheimer’s disease, non-Alzheimer’s disease, and Parkinson disease; an increased risk of Parkinson’s disease was also observed in combined androgen blockade group. Interestingly, the duration of ADT showed no association with cognitive dysfunction, however even patients with <6 months of ADT utilization demonstrated a level of cognitive decline:
Dr. Huang concluded his talk noting that this population-based study demonstrated that antiandrogen use alone was associated with a high risk of overall cognitive dysfunction, dementia, and Parkinson’s disease. Furthermore, the risk of overall cognitive decline and Parkinson’s disease was also higher in combined androgen blockade group. Different ADT therapies may have unequal impact on cognitive dysfunction, although the reasons behind these differences are currently not known.
Presented by: Cheng-Yu Huang, Chung-Shan Medical University, Taichung City, Taiwan
Co-Authors: Ming-Chieh Kuo, Chi-Shin Tseng, Chao-Yuan Huang, Cheng-Yu Huang*, Taipei City, Taiwan, Chao-Hsiang Chang, Chih-Hsin Muo, Chi-Jung Chung, Taichung City, Taiwan
Written By: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University - Medical College of Georgia @zklaassen_md at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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