Androgen deprivation therapy may be linked with dementia in prostate cancer

Androgen deprivation therapy may be associated with an increased risk for dementia in patients with prostate cancer, according to a systematic review and meta-analysis.

However, although the literature supported an association between androgen deprivation therapy and dementia, researchers found no direct evidence that the therapy caused dementia.

“Recent analyses have suggested a link between the use of androgen deprivation therapy in the treatment of prostate cancer and an increased risk of dementia,” Kevin T. Nead, MD, MPhil, a resident of the department of radiation oncology at the Perelman Center for Advanced Medicine, University of Pennsylvania, and colleagues wrote. “However, other studies have failed to support this association, including the largest study examining this association to date. … A comprehensive analysis of this rapidly evolving and controversial topic has not been undertaken and the clinical implications of these findings taken collectively are unclear.”

Nead and colleagues used multiple databases to review nine studies describing dementia outcomes in patients undergoing treatment for prostate cancer. Seven of the studies included an adjusted-effect estimate of dementia risk.

A meta-analysis of 50,541 patients showed an increased risk for dementia among patients who underwent androgen deprivation therapy (HR = 1.47; 95% CI, 1.08-2). The researchers analyzed Alzheimer disease and all-cause dementia separately (HR = 1.46; 95% CI, 1.05-2.02 for all-cause dementia; HR = 1.25; 95% CI, 0.99-1.57 for Alzheimer disease). Researchers reported finding no evidence of bias from small study effects.

“The existing literature supports an association between androgen deprivation therapy and dementia. However, we do not currently have evidence that androgen deprivation therapy causes dementia,” Nead said. “This study adds to a growing body of literature that androgen deprivation therapy may impact neurocognitive function, in addition to other established adverse effects, and further underscores the importance of appropriate patient selection for androgen deprivation therapy.” – by Andy Polhamus

Disclosure: Nead reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.