Is Androgen Deprivation Therapy for Prostate Cancer Linked to Dementia?

CHICAGO -- October 13, 2016 -- Androgen deprivation therapy (ADT) appears to be associated with an increased risk for dementia, according to a study published online by JAMA Oncology.

Although ADT has shown survival benefit in some patients with prostate cancer, it has also been associated with some adverse health effects, including a possible link to neurocognitive dysfunction.

For the current study, Kevin T. Nead, MD, formerly of Stanford University School of Medicine, Stanford, California, now with University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, and colleagues used an informatics approach with a text-processing method to analyse electronic medical records data (1994-2013) to examine ADT and the subsequent development of dementia.

The final study group included 9,272 men with prostate cancer, including 1,862 (19.7%) who received ADT.

There were 314 new cases of dementia during a media follow-up of 3.4 years with a median time to dementia of 4 years.

The absolute increased risk of developing dementia among those men who received ADT was 4.4% at 5 years.

Further analysis suggests men who received ADT at least 12 months had the greatest absolute increased risk of dementia. Men aged 70 years and older who received ADT were the least likely to remain free of dementia.

The report suggests several plausible mechanisms to explain an association between ADT and dementia in general, including that androgens have a demonstrated role in neuron health and growth.

Study limitations include using clinical text documentation and billing codes to determine a diagnosis of dementia. Because of its design, the study also cannot determine a causal association between the use of ADT and the risk of dementia.

“Our study extends previous work supporting an association between use of ADT and Alzheimer disease and suggests that ADT may more broadly affect neurocognitive function,” the authors wrote. “This finding should be investigated in prospective studies given significant individual patient and health system implications if there are higher rates of dementia among the large groups of patients undergoing ADT.”

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