The Link Between Androgen Deprivation Therapy (ADT) and Dementia in Men with Prostate Cancer

The link between androgen deprivation therapy (ADT) and dementia in men with prostate cancer is still unclear. Researchers have found in a new study that exposure to cumulative androgen deprivation therapy (ADT) increases the risk of dementia. Therefore, the goal is to reduce the amount of male hormones in the body, known as androgens, or to prevent them from fueling prostate cancer cells. But this needs to be done judiciously.

The findings of this study were published in The Journal of Urology on 2nd December, 2021.

Researchers examined the relationship between cumulative ADT exposure and the onset of dementia in a nationwide longitudinal registry of men with prostate cancer in this study. In this study, the CaPSURE registry was used to conduct a retrospective analysis of men aged 50 years. The primary outcome was the development of dementia following primary treatment. Total ADT exposure was expressed as a time-varying independent variable of ADT exposure. A propensity score was used to estimate the likelihood of receiving ADT. Cox proportional hazards regression was used to determine the relationship between ADT exposure and dementia with competing risk of death in men receiving various treatments, after controlling for propensity score and clinical covariates.

Findings of the Study

• After a median of 7.0 years (interquartile range [IQR] 3.0–12.0) of follow-up, 317 (2.3%) of 13,570 men were diagnosed with dementia.
• After adjustment, cumulative ADT use was associated with dementia (hazard ratio [HR] 2.02; 95 percent CI, 1.40–2.91; p 0.01).
• There was also an association between ADT use and dementia in a subset of 8,506 men, propensity score matched by whether or not they received ADT (HR 1.59; 95 percent CI, 1.03–2.44; p=0.04).
• There was no link between primary treatment type and dementia onset in the cohort of 8,489 men who did not receive ADT.

In conclusion, while planning the ADT therapy, the increased risk should be accompanied by a thorough discussion of the needs and benefits of ADT in those contemplating treatment.

Reference: Androgen Deprivation Therapy and the Risk of Dementia after Treatment for Prostate Cancer. Peter E. Lonergan, Samuel L. Washington III, Janet E. Cowan, Shoujun Zhao, Jeanette M. Broering, Matthew R. Cooperberg, and Peter R. Carroll. https://doi.org/10.1097/JU.0000000000002335