Long-Term ADT for Prostate Cancer: Cognitive Function and Decision-Making
Posted: Monday, August 31, 2020
A recent article published in Psycho-Oncology discussed the influence of artificially decreased testosterone on emotional behaviors, different aspects of cognition, and life quality in elderly men with advanced prostate cancer. Esther Kristina Diekhof, PhD, of the Universität Hamburg, Germany, and colleagues found that androgen-deprivation therapy (ADT) significantly reduced free testosterone concentrations and appeared to be negatively associated with visuospatial performance. They also found that depression severity, cognitive capacity, and quality of life were negatively affected by this antihormone treatment.
A total of 68 men between the ages of 50 and 79 were recruited for this study. Free testosterone concentrations of 46 patients with prostate cancer (no chemotherapy) and 22 healthy controls were measured using saliva. Of the patients with prostate cancer, 24 received long‐term antihormone treatment, whereas the remaining 22 patients did not receive any testosterone treatment. The Wechsler Adult Intelligence Scale IV was used to measure visuospatial performance and cognitive abilities such as logical thinking and hand-eye coordination. The Mini Mental State examination was further used to screen participants for cognitive impairment, whereas the Beck Depression Inventory and the ultimatum game were used to assess depression level and socioeconomic decision‐making, respectively.
Their findings revealed a main effect of Z‐testosterone concentration on visual-motor performance (P = .042), differences in cognitive impairment (P = .005), and increased depression scores in patients who received antihormone therapy. They also found that compared with untreated patients, patients who received antihormone treatment had a reduced intergroup bias during socioeconomic decision-making (P < .001).
Dr. Diekhof and colleagues concluded: “The negative side effects of [antihormone therapy] cannot outweigh [its] benefits on the course of advanced prostate cancer. Clinicians should be aware that some androgen‐deprived prostate cancer patients develop neurocognitive impairments yet fail to seek psychological help….”
Disclosure: The authors reported no conflicts of interest.