Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial

Abstract

Objective To report the first systematic investigation of the cognitive effects of luteinizing hormone-releasing hormone (LHRH) analogues in male patients, as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions. Patients and methods Eighty-two men with extraprostatic prostate cancer were randomly assigned to receive either continuous leuprorelin, goserelin (both LHRH analogues), cyproterone acetate (a steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before starting treatment (77), and then 6 months later (65).Results Compared with the baseline assessments, men receiving androgen suppression monotherapy performed worse in two of 12 tests of attention and memory; 24 of 50 men randomized to active treatment and assessed 6 months later had a clinically significant decline in one or more cognitive tests but not one patient randomized to close monitoring showed a decline in any test performance. Conclusion Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions.

Intermittent Androgen Suppression for Rising PSA Level After Radiotherapy

“…[21][22][23][24][25][26][27] All adverse events associated with perprotocol treatment are shown in Table S3 in the Supplementary Appendix. The early diagnosis of failure of definitive treatment, as determined according to the PSA level, subjects otherwise asymptomatic men to many years of androgen deprivation, adversely affecting their quality of life.…”

Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

“…Hormonal challenges in men via administration of luteinising hormone-releasing hormone agonists, such as leuprolide or goserelin, also may adversely affect hippocampal function through these hormonal channels. There are inconsistent findings with regard to the safety profile of androgen ablating agents, with some authors reporting no evidence of neurocognitive decline or neurobehavioural dysfunction (Salminen et al, 2003), and others finding impaired memory, attention, and executive function (Green et al, 2002).…”

Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy

“…Low testosterone levels may, in fact, alter serotonin neurotransmission [8], negatively affecting mood as demonstrated in animal models [9]. Also, testosterone deficiency may decrease cerebral perfusion in the brain regions involved in memory, reasoning, judgment, and emotions [10], leading to a deterioration in mental and overall wellbeing [11,12]. Studies in elderly subjects and non-cancer patients have reported a clear association between testosterone levels and depressive symptoms [13]: lower testosterone levels in older men have been associated with more depressive symptoms [14,15], which seem to disappear with testosterone hormone treatment [16,17].…”