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 Prostate cancer cells need testosterone to grow and spread.
Researchers focused on a common treatment known as androgen
deprivation therapy (ADT), which works by depriving tumor cells of
testosterone. Side effects can include sexual dysfunction, weight
gain and fatigue.
“Multiple studies now suggest that androgen deprivation therapy may
be associated with cognitive changes, including dementia, and the
current study certainly supports this,” said lead study author Dr.
Kevin Nead of the University of Pennsylvania in Philadelphia.
Patients with prostate cancer who received hormone therapy were more
than twice as likely to develop dementia as men who received
alternative treatments, Nead and his colleagues found.
“There is certainly a concern that we may be over treating some men
with prostate cancer and the current study reinforces the importance
of appropriately and thoughtfully selecting patients for all
treatments,” Nead, who conducted the research at Stanford
University, added by email.
To explore the link between hormone therapy and dementia, Nead’s
team analyzed data on 9,272 men with prostate cancer treated at an
academic medical center from 1994 to 2013.The study group included
1,826 men who were treated with ADT.
Men were typically around 67 years old, on average, though the
patients on ADT tended to be older. Researchers followed half of
them for at least 3.4 years.
Overall, 7.9 percent of men who received hormones developed dementia
within five years, compared with 3.5 percent of men who got other
treatments, researchers report in JAMA Oncology.
Men had a greater risk of dementia if they stayed on ADT for at
least one year compared to taking hormones for a shorter period of
time, the study also found.
Risk also appeared to increase with age, with men 70 years and older
who used hormones less likely to remain dementia-free.
Limitations of the study include the lack of data for some of the
men in the study on the severity of prostate tumors, the authors
note.
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Another drawback is the observational design of the study, Dr. Colin
Walsh and Dr. Kevin Johnson of Vanderbilt University in Nashville,
Tennessee, note in an accompanying editorial. A trial that randomly
assigns some men to ADT and others to different therapies would be
needed to see if the hormones directly cause dementia, they write.
It’s also possible that at least some of the difference in dementia
risk found in the study might be due to the characteristics of
patients on ADT, said Dr. Paul Nguyen, a researcher at Brigham and
Women’s Hospital and Harvard Medical School in Boston who wasn’t
involved in the study. Men on hormone therapy tend to be older and
sicker, with more underlying health issues.
Even so, the findings add to growing evidence suggesting that men
should consider the cognitive risks of hormone therapy before
starting this treatment, Nguyen said.
“For high risk or locally advanced prostate cancer treated with
radiation, we know from randomized trials that ADT cuts the risk of
death in half and so for these men, ADT should generally still be
used,” he said by email. “For low risk men, ADT has no benefit and
should be avoided.”
SOURCE: http://bit.ly/2dInfKD and http://bit.ly/2eNJmDz JAMA
Oncology, online October 13, 2016.
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