Effects of long‐term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer

• Published in: Cancer Vol. 123; no. 2; pp. 237 - 244
• Main Authors: Alibhai, Shabbir M.H., Timilshina, Narhari, Duff‐Canning, Sarah, Breunis, Henriette, Tannock, Ian F., Naglie, Gary, Fleshner, Neil E., Krahn, Murray D., Warde, Padraig, Marzouk, Shireen, Tomlinson, George A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2017
• Subjects: adverse effects; Age; Aged; Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; androgen deprivation therapy; Androgens; Cancer; Case-Control Studies; Cognition - drug effects; Cognition Disorders - chemically induced; Cognitive ability; cognitive function; cohort study; Deprivation; Education; Humans; Male; Men; Missing data; neuropsychological testing; Neuropsychological Tests; Oncology; Patients; Prostate cancer; Prostatic Neoplasms - drug therapy; Regression analysis; Sensitivity analysis; Standard deviation; Statistical analysis; Therapy; androgen deprivation therapy; cognitive function; adverse effects; neuropsychological testing; prostate cancer; cohort study
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.30320

BACKGROUND Many men with prostate cancer (PC) require long‐term androgen deprivation therapy (ADT), but to the authors' knowledge, its effects on cognitive function beyond 1 year are not described. METHODS Three groups of men aged ≥50 years who were matched based on age and education were enrolled: 77 patients with nonmetastatic PC who initiated continuous ADT, 82 patients with PC who were not receiving ADT (PC controls), and 82 healthy controls. A battery of 14 neuropsychological tests, examining 8 cognitive domains, was administered on 5 occasions over 36 months. Changes in cognitive scores over time were analyzed using 3 approaches: linear mixed effects regression, the percentage of participants per group with declines in ≥1/2 cognitive tests, and a global summary of cognitive change. RESULTS The mean age of the study subjects was 68.9 years, with a median of 16 years of education. In mixed effects models adjusted for age and education, ADT use was not found to be associated with significant changes over time in any cognitive test compared with healthy controls. The percentage of participants declining by ≥1.5 standard deviations in ≥2 tests or ≥2 standard deviations in ≥1 tests was similar across groups. A global summary of cognitive change found no statistically significant worsening of cognitive function among ADT users compared with controls. Sensitivity analyses adjusting for duration of ADT and using multiple imputation for missing data did not materially alter the study findings. CONCLUSIONS The ongoing use of ADT for up to 36 months does not appear to be associated with cognitive decline. Cancer 2017;123:237–244. © 2016 American Cancer Society. Many men with prostate cancer require long‐term androgen deprivation therapy (ADT), but to the authors' knowledge, its effects on cognitive function beyond 1 year have not been described. In this prospective, matched cohort study of 77 men with nonmetastatic prostate cancer who were receiving ADT and 2 control groups, the authors report no evidence of worsening cognitive function with up to 3 years of ADT use compared with controls.