Hormone therapy for prostate cancer can increase the risk of Alzheimer's disease

Researchers at the University of Pennsylvania discovered that men on blocking hormone treatment for prostate cancer were at increased risk of developing dementia and Alzheimer's disease compared to patients not receiving treatment.

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In a study of 154,089 older men diagnosed with prostate cancer between 1996 and 2003, those who received androgen deprivation treatment had a 20% higher risk of being diagnosed. with dementia and a 14% greater risk of being diagnosed with Alzheimer's disease compared to the following: ten years. The risk of being diagnosed with these conditions continued to increase, plus the dose of treatment received by men was high.

Patients with prostate cancer who are taking drugs to block the androgen that promotes tumor growth may experience various side effects, including bone loss, heart problems, obesity and kidney disease. # 39; impotence. Other common side effects include mood swings, sleep disturbances, headaches, hot flashes, and hyperglycemia.

Now, a study by Ravishankar Jayadevappa and colleagues suggests that an increased risk of dementia is another potential disadvantage of treatment.

Jayadevappa says the findings suggest that in cases where the cancer is localized, the administration of androgen deprivation treatment may not be the best choice and that even high-risk patients should be warned of the increased risk of these conditions.

The researchers noted that, until now, studies on the cognitive effects badociated with therapy had generated mixed results. In an attempt to produce more definitive conclusions, Jayadevappa and his team used data from the Surveillance, Epidemiology and End-Use Database of the National Cancer Institute of Medicare. The database contains information on cancer incidence, treatment and death at 18 sites in the United States and links it to Medicare data.

Men aged 66 and over had been diagnosed with localized or metastasized prostate cancer between 1996 and 2003 and had been followed until 2013, so that all men had been evaluated for at least ten years.

Of the men included in the study, 62,330 had received antiandrogenic treatment within two years of diagnosis.

During the follow-up period, 13.1% of people who received the treatment had been diagnosed with Alzheimer's, compared to 9.4% of those who had not received treatment. Similarly, 21.6% of people who received the therapy were diagnosed with type of dementia, compared to 15.8% of those who did not.

The risk for these conditions also increased plus the exposure to treatment was important; Men who received up to four doses were 19% more likely to get one or the other of these diseases, while those who received eight or more doses were at 24% higher risk. high for Alzheimer's disease and a 21% greater risk of dementia.

Researchers call for the use of androgen deprivation therapy (ADD) as a last resort

Catherine Marshall, Assistant Professor at Johns Hopkins in Baltimore, Maryland, welcomes the study and says:

Although this question of a link between ADD and Alzheimer's disease and dementia has already been explored, it is probably the largest study on this topic. For this reason, he adds important information about the risk of Alzheimer's disease and dementia in men treated. "

Write in JAMA Network open nowJayadevappa and colleagues say clinicians must carefully weigh the risks and long-term benefits of exposure to androgen deprivation in patients with long-term life expectancy and stratify patients according to the risk of dementia before the beginning of androgen deficiency treatment.

"Delaying the start of ADT treatment until the disease is more advanced could be a reasonable option for many men and would help reduce the overall duration of treatment," Marshall adds.

Last month, Karl Tully and his colleagues, researchers at the Brigham and Women's Boston Hospital, presented similar findings at the annual meeting of the American Urological Association in Chicago.

For this study, the team collected available data on more than 100,400 men enrolled in Medicare diagnosed with prostate cancer between January 1992 and December 2009.

Tully and her team found that the risk of developing any type of dementia was increased by 17% in men treated with androgen therapy and 23% in those with Alzheimer's disease.

Androgen deprivation therapy may not only cause physical changes such as osteoporosis, cardiovascular disease or obesity, but may also result in changes in cognition (…) doctors should inform their patients of this risk and should probably do regular screening. "

Karl Tully, Brigham and Women's Hospital

The decision to delay the ADT should not be taken lightly

However, Elizabeth Kavaler, Urology Specialist at Lenox Hill Hospital in New York, does not think that it is necessary to inform patients of the badociation because she believes that the increase in the incidence Dementia may not have been caused by treatment and many patients may have had it. other health problems that could have increased their risk of dementia.

She also notes that many patients with prostate cancer may not have another solution:

"We really do not have a choice.Androgen deprivation therapy is what can be offered to men with recurrent or advanced prostate cancer.It is treat a life-threatening illness as opposed to the risk of developing a life-threatening illness. "

"How do you ask someone to choose between losing their head or not treating their high-risk disease.It is a difficult position in which to place a patient.I would not even have it." mentioned. "

Jayadevappa also believes that in advanced cancer cases, therapy can save lives and should not be avoided because it fears an increased risk of dementia. However, "patients with localized cancer should look at the risks of dementia and possibly avoid DAA," he concludes.