Androgen deprivation therapy (ADT) remains the mainstay treatment for locally advanced or metastatic prostate cancer (PC). However, potential effects of ADT treatment on neurocognitive dysfunction remain unclear. The present study was conducted to assess the relation between ADT treatment and risk of cognitive decline in Asian men with PC.
A population-based cohort of 24,464 men with PC, each newly diagnosed between 2000 and 2008, was selected from the Taiwan National Health Insurance Database. Subjects were further grouped by treatment as non-ADT (n = 4685) or ADT (n = 12,740), members of the latter subjected to bilateral orchiectomy or medical treatment (ie, luteinizing hormone-releasing hormone agonists, antiandrogens, or combination therapy). A multivariable Cox proportional hazard model with ADT as time-dependent covariate was used to generate adjusted hazard ratios (HRs) of subsequent cognitive decline, including dementia, Alzheimer's disease (AD), and Parkinson's disease (PD).
ADT showed a significant association with overall risk of cognitive decline (HR = 1.51, 95 % CI: 1.31-1.74), especially for PD, dementia, and non-Alzheimer dementia (non-AZD). When stratified by various ADT regimens, antiandrogen-only recipients displayed significantly heightened risks of subsequent AD, non-AZD, and PD. However, combined androgen blockade also imposed an increased risk of PD. There was no apparent correlation between duration of ADT exposure and cognitive dysfunction.
Various ADT therapies may have disparate impacts on cognitive function. Prospective studies exploring pertinent clinical characteristics more fully are needed to confirm these findings.
Cancer epidemiology. 2020 Jan 06 [Epub ahead of print]
Jian-Hua Hong, Chao-Yuan Huang, Chao-Hsiang Chang, Chih-Hsin Muo, Fu-Shan Jaw, Yu-Chuan Lu, Chi-Jung Chung
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: ., Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: ., Department of Urology, China Medical University and Hospital, Taichung, Taiwan; Department of Medicine, College of Medicine, China Medical University and Hospital, Taichung, Taiwan. Electronic address: ., Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan. Electronic address: ., Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan. Electronic address: ., Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: ., Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. Electronic address: .