Androgen-Deprivation Therapy and Risk of Dementia in Men With Prostate Cancer
Posted: Friday, July 19, 2019
Elderly men exposed to androgen-deprivation therapy for prostate cancer may be at a higher risk of Alzheimer’s disease and other forms of dementia. The retrospective cohort study conducted by Ravishankar Jayadevappa, PhD, of the University of Pennsylvania’s Perelman School of Medicine, and colleagues, found that the risk of dementia increased with the amount of exposure to the hormone therapy. The findings were published in JAMA Network Open.
“Our results suggest that clinicians need to carefully weigh the long-term risks and benefits of exposure to [androgen-deprivation therapy] in patients with a prolonged life expectancy and stratify patients based on dementia risk prior to [androgen-deprivation therapy] initiation,” the researchers concluded.
Researchers analyzed data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results–Medicare database of 154,089 elderly men diagnosed with prostate cancer between 1996 and 2003. A total of 62,330 had received androgen-deprivation therapy within 2 years of their cancer diagnosis, and 91,759 did not.
With an average follow-up of 8 years, the investigators found that more patients treated with androgen-deprivation therapy were diagnosed with Alzheimer’s disease than those who did not receive the hormone therapy (13.1% vs. 9.4%; P < .001). In addition, dementia was diagnosed in 21.6% of patients exposed to androgen-deprivation therapy compared with 15.8% of those who were not (P < .001).
Furthermore, a dose-response relationship was identified by the investigators. The hazard ratio was 1.19 for Alzheimer’s disease and for dementia in patients treated with one to four doses of hormone therapy, compared with 1.24 and 1.21, respectively, in patients treated with more than eight doses of androgen-deprivation therapy.
“It is possible that [androgen-deprivation therapy] has a modifying or augmenting, rather than de novo, effect on [the] development of dementia,” the investigators proposed. “Further work could be done to characterize individuals undergoing [androgen-deprivation therapy] who are at high risk of developing earlier dementia.”
Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.
