Prostate Cancer Hormone Therapy Ups Dementia Risk

Androgen deprivation therapy (ADT) for prostate cancer is associated with an increased risk of dementia, according to separate studies presented at the 2019 American Urological Association annual meeting.

In a study of 100,414 men with PCa aged 66 years or older—37,911 (38%) of whom received ADT within 6 months of diagnosis—receipt of any pharmacologic ADT, compared with no ADT, was significantly associated with a 22% increased risk of dementia from any cause, 29% increased risk of Alzheimer’s disease, and 15% increased risk of psychiatric services use, Karl Heinrich Tully, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, reported on behalf of his research team.

The investigators observed a dose-response relationship, with ADT duration of 7 months or longer significantly associated with a 30% and 41% increased risk of all-cause dementia and Alzheimer’s disease, respectively, compared with no ADT. They observed no dose-response relationship between ADT and use of psychiatric services.

The findings come from a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The study excluded men with a prior history of stroke, dementia, or use of psychiatric services reported in Medicare claims. The cohort included men diagnosed with localized or locally advanced PCa from January 1992 to December 2009 and followed up until the administrative end of follow-up at 36 months or death.

Separately, in a population-based study of 24,464 men with newly diagnosed PCa, Ming-Chieh Kuo, MD, of Chung-Shan Medical University in Taipei City, Taiwan, and colleagues found a significant 51% increased risk of overall cognitive decline, 38% increased risk of dementia, and 83% increased risk of Parkinson’s disease among men who received ADT compared with those who did not.

The increased risk differed by ADT type. Use of oral antiandrogens was significantly associated with 70% and 54% increased risks of overall cognitive dysfunction and overall dementia, but was not associated with Alzheimer’s dementia. Combined androgen blockade was significantly associated with a 27% increased risk for overall cognitive dysfunction but not overall dementia or Alzheimer’s dementia. Luteinizing hormone-releasing hormone (LHRH) agonists and bilateral orchiectomy were not associated with cognitive dysfunction.

In addition, the investigators found that oral antiandrogens were significantly associated with a 51% increased risk of non-Alzheimer’s dementia and 6.6-fold increased risk of Parkinson’s disease, whereas LHRH agonists were not associated with either of these conditions.

Also at the meeting, South Korean investigators reported on population-based study showing that ADT for PCa was associated with cognitive dysfunction. The study, presented by Jae Young Park, MD, of Korea University College of Medicine in Ansan, included 35,410 patients with PCa identified using South Korea’s National Health Insurance Service Database. Of these, 24,567 (70.6%) underwent ADT. During a mean follow-up of 4.1 years, 4741 patients were newly diagnosed with cognitive dysfunction. ADT was associated with a significant 17% increased risk of cognitive dysfunction.

Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.

References

Krasnova A, Tully KH, Epstein M, et al. Risk of dementia following androgen deprivation therapy for treatment of prostate cancer. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract PD30-12.

Kuo MC, Tseng CS, Huang CY, et al. Different androgen deprivation therapies have unequally impact on cognitive dysfunction—an analysis from a population-based study using time-dependent exposure model. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract PD15-02.

Sik TB, Choi H, Park JY, et al. Correlation of androgen deprivation therapy with cognitive dysfunction in patients with prostate cancer: A nationwide population-based study using the National Health Insurance Service Database.  Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract PD30-11.

Prostate Cancer Hormone Therapy Ups Dementia Risk