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

Tae, Bum Sik; Jeon, Byeong Jun; Shin, Seon Hee; Choi, Hoon; Bae, Jae Hyun; Park, Jae Young

doi:10.4143/crt.2018.119

Cited by 40 publications

(37 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies analysed the association between ADT and any dementia or Alzheimer's dementia in men with prostate cancer using men with prostate cancer but unexposed to ADT as reference . These studies reported an increased risk of Alzheimer's dementia (HR 1.66 [95% CI 1.05–2.64]) and any dementia (HR 2.21 [95% CI 1.72–2.83] and HR 1.17 [95% CI 1.08–1.27]).…”

Section: Discussionmentioning

confidence: 99%

“…Androgen deprivation therapy for prostate cancer has been suggested to be associated with decreased cognitive function . Three large studies found an increased risk of Alzheimer's dementia or overall dementia . In these studies, men with prostate cancer on ADT were compared with men with prostate cancer not on ADT, making it difficult to determine whether the increased risk of dementia was caused by ADT, by prostate cancer per se , or by the fact that men with undiagnosed dementia were more likely to receive ADT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Androgen deprivation therapy for prostate cancer and risk of dementia

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo study whether androgen deprivation therapy (ADT), the mainstay treatment for advanced and disseminated prostate cancer, is associated with risk of dementia. MethodsRisk of dementia in men with prostate cancer primarily managed with ADT or watchful waiting (WW) in the Prostate Cancer Database Sweden, PCBaSe, was compared with that in prostate cancer-free men, matched on birth year and county of residency. We used Cox regression to calculate the hazard ratios (HRs) for Alzheimer's and non-Alzheimer's dementia (vascular dementia, dementia secondary to other diseases or unspecified dementias) for different types and duration of ADT and oral antiandrogens (AAs) as well as for men managed with WW. ResultsA total of 25 967 men with prostate cancer and 121 018 prostate cancer-free men were followed for a median of 4 years. In both groups 6% of the men were diagnosed with dementia. In men with prostate cancer, gonadotropinreleasing hormone agonist treatment ( HR 1.15, 95% confidence interval [CI] 1.07-1.23) and orchiectomy (HR 1.60, 95% CI 1.32-1.93) were associated with an increased risk of dementia, as compared to no treatment in prostate cancer-free men; however, this increase in risk was only observed for non-Alzheimer's dementia and occurred from year 1-4 after start of ADT. No increase in risk for any type of dementia was observed for men treated with AAs or for men on WW. ConclusionThis population-based cohort study does not support previous observations of an increased risk of Alzheimer's dementia for men on ADT; however, there was a small increase in risk of non-Alzheimer's dementia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Androgen deprivation therapy for prostate cancer and risk of dementia

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A population-based study using the Korean National Health Insurance Service database analyzed the data on ADT and cognitive dysfunction between 2008 and 2015 in the Korean PC population, excluding patients with a previous diagnosis of cognitive dysfunction, dementia, or cerebral event history (N = 35,401). The authors reported a statistically significant association between ADT and the risk of cognitive dysfunction (HR 1.169; P = 0.002) [47].…”

Section: Adt-mediated Cns Effectsmentioning

confidence: 97%

A review of prostate cancer treatment impact on the CNS and cognitive function

Ryan

Wefel

Morgans

2019

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

Background Androgen deprivation therapy (ADT) is the backbone of systemic therapy for men with prostate cancer (PC); almost one-half of patients receive treatment during their disease course. However, a range of cognitive and other central nervous system (CNS) changes have been associated with ADT. In this review, we discuss extant data describing these complications and the mechanisms through which medications used to deliver ADT may affect them. Methods We performed a MEDLINE search for appropriate papers published between January 2000 and December 2018. Relevant papers were selected and reviewed; additional publications were identified by manually assessing references from included papers, and recent congress abstracts. Results Of~230 search outputs, 33 were selected for inclusion. Some studies suggested a clear association between ADT and CNS effects in men with PC, whereas others did not. Accurate assessment is limited by test instrument variability, inadequate sample sizes, short follow-up duration, and limited prospective longitudinal studies. The approved secondgeneration androgen receptor (AR) inhibitors enzalutamide and apalutamide were associated with some CNS-related adverse events (AEs) in clinical studies, including fatigue (which can interfere with cognitive function). The androgen synthesis inhibitor abiraterone acetate was associated with a low CNS AE profile when compared with enzalutamide. The AR antagonist darolutamide demonstrated a comparable incidence of cognitive disorder in clinical trials to that of ADT alone. Conclusions Adequately caring for men receiving ADT requires an understanding of the symptoms, incidence and magnitude of cognitive effects, and a feasible approach to cognitive assessment and management in clinical settings. Some CNS effects could relate to blood-brain barrier penetration and direct AR inhibitor activity; drug safety profiles may differ by the degree of blood-brain barrier penetration of particular agents. Ongoing clinical trials seek to define the CNS tolerability of newer AR pathway-targeted therapy options more clearly.

show abstract

“…Previous studies analysed the association between ADT and any dementia or Alzheimer's dementia in men with prostate cancer using men with prostate cancer but unexposed to ADT as reference [9][10][11]. These studies reported an increased risk of Alzheimer's dementia ( increase in risk of dementia in men on ADT for nonmetastatic prostate cancer compared to men with prostate cancer not treated with ADT: HR 1.02 (95% CI 0.87-1.…”

Section: Discussionmentioning

confidence: 99%

“…Androgen deprivation therapy for prostate cancer has been suggested to be associated with decreased cognitive function [8]. Three large studies found an increased risk of Alzheimer's dementia [9] or overall dementia [10,11]. In these studies, men with prostate cancer on ADT were compared with men with prostate cancer not on ADT, making it difficult to determine whether the increased risk of dementia was caused by ADT, by prostate cancer per se, or by the fact that men with undiagnosed dementia were more likely to receive ADT.…”

Section: Introductionmentioning

confidence: 99%

Androgen deprivation therapy for prostate cancer and risk of dementia

Robinson¹,

Garmo²,

Hemelrijck³

et al. 2018

European Urology Supplements

View full text Add to dashboard Cite

To study whether androgen deprivation therapy (ADT), the mainstay treatment for advanced and disseminated prostate cancer, is associated with risk of dementia. Methods Risk of dementia in men with prostate cancer primarily managed with ADT or watchful waiting (WW) in the Prostate Cancer Database Sweden, PCBaSe, was compared with that in prostate cancer-free men, matched on birth year and county of residency. We used Cox regression to calculate the hazard ratios (HRs) for Alzheimer's and non-Alzheimer's dementia (vascular dementia, dementia secondary to other diseases or unspecified dementias) for different types and duration of ADT and oral antiandrogens (AAs) as well as for men managed with WW. Results A total of 25 967 men with prostate cancer and 121 018 prostate cancer-free men were followed for a median of 4 years. In both groups 6% of the men were diagnosed with dementia. In men with prostate cancer, gonadotropinreleasing hormone agonist treatment (HR 1.15, 95% confidence interval [CI] 1.07-1.23) and orchiectomy (HR 1.60, 95% CI 1.32-1.93) were associated with an increased risk of dementia, as compared to no treatment in prostate cancer-free men; however, this increase in risk was only observed for non-Alzheimer's dementia and occurred from year 1-4 after start of ADT. No increase in risk for any type of dementia was observed for men treated with AAs or for men on WW. Conclusion This population-based cohort study does not support previous observations of an increased risk of Alzheimer's dementia for men on ADT; however, there was a small increase in risk of non-Alzheimer's dementia.

show abstract

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

Abstract: Our results revealed an association between the use of ADT for the treatment of prostate cancer and an increased risk of cognitive dysfunction in a nationwide population-based study. This finding should be further evaluated in prospective studies.

Cited by 40 publications

References 35 publications

Androgen deprivation therapy for prostate cancer and risk of dementia

Androgen deprivation therapy for prostate cancer and risk of dementia

A review of prostate cancer treatment impact on the CNS and cognitive function

Androgen deprivation therapy for prostate cancer and risk of dementia

Contact Info

Product

Resources

About