Newswire (Published: Wednesday, July 24, 2019, Received: Wednesday, July 24, 2019, 4:04:43 PM CDT)
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2019 JUL 24 (NewsRx) -- By a
Of the 154,089 men sampled in the study, 62,330 received ADT within two years of their prostate cancer diagnosis and 91,759 did not. Of the patients with prostate cancer who received the hormone therapy, 13 percent were later diagnosed with Alzheimer’s disease, compared to 9 percent who did not receive ADT. For dementia, those numbers widened: 22 percent of prostate cancer patients who received ADT were diagnosed with dementia, compared to 16 percent who did not receive the therapy. This research builds on previous, smaller studies which showed similar correlations between hormone therapy and cognitive risks in patients with prostate cancer. The lifetime risk for Alzheimer’s dementia for men overall is 12 percent, according to data from the Framingham Heart Study.
“To our knowledge, this is one of the largest studies to date examining this association, and it followed patients for an average of eight years after their prostate cancer diagnosis. Our results suggest that clinicians need to raise their awareness about potential long-term cognitive effects of hormone therapy and discuss these risks with their patients,” said the study’s principal investigator
Prostate cancer is the most commonly diagnosed non-skin cancer in
Despite the benefits of ADT, its use has faced controversy, as some evidence suggests that decreasing androgen levels may increase risk factors for Alzheimer’s and dementia, including loss of lean body mass, diabetes, cardiovascular disease, and depression. Hormone therapy may also affect cognitive function by impairing neuron growth and the regeneration of axons.
After controlling for several factors, such as other medical conditions, disease severity and sociodemographic characteristics -- like age and marital status -- the Penn researchers determined the hazard ratio for prostate cancer patients who receive hormone therapy. A hazard ratio measures the effect of an intervention over time. With all other factors remaining equal, the research team determined that patients with prostate cancer who receive hormone therapy face a hazard ratio that translate to a 14 percent increased risk of developing Alzheimer’s and a 20 percent increased risk of dementia, when compared to other prostate cancer patients who are not exposed to ADT.
The Penn study contrasts with results from several recent papers that have examined the association -- or lack thereof -- between ADT and dementia. These past studies relied on data from a single institution, while others fail to adjust for cancer stage, ADT dose, and duration. Many examined a small cohort of patients and only for a short amount of time following their treatment.
By contrast, Jayadevappa’s team used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database of the
The team noted more research is necessary to understand the possible biological mechanisms that underlie the link between dementia and ADT. As to whether physicians should advise their patients regarding the risk of hormone therapy, it may depend on the patient and the severity of his or her disease, cautioned study co-author
“I think we need to look at these patients on an individual level. Certainly there are patients who need hormonal therapy and benefit from it greatly,” Guzzo said. “There are others where the evidence is less clear, and in these patients, we should strongly consider the risk of hormonal therapy versus the benefit in treating their prostate cancer. This should be a shared decision-making process with the patient.”
(Our reports deliver fact-based news of research and discoveries from around the world.)