Warning to Prostate Cancer Patients

Many oncologists that treat prostate cancer patients insist on using androgen-deprivation therapy (ADT) that blocks male hormone production and release. Most prostate cancer patients are informed about the numerous side-effects such as hot flashes, metabolic syndrome/weight gain, muscle mass loss, gynecomastia (developing breast tissue), and osteoporosis.

The vast majority of men receiving continuous ADT who are potent prior to therapy develop sexual dysfunction. Loss of libido in men receiving ADT usually develops within the first several months, and erectile dysfunction follows.

Recovery of erectile function is possible after discontinuation of short-term ADT (6 months or less),  however, it may be delayed and incomplete.

More difficult to assess and manage is the potential impact of ADT on cognitive function. Compelling data on this topic have been in short supply, but in a high-volume prostate cancer practice a substantial minority of patients report changes in cognitive function, often described as a loss of “sharpness” following ADT.

Warning to Prostate Cancer PatientsTo assess the effect of ADT on cognitive performance, investigators prospectively studied three groups of individuals: 58 prostate cancer patients receiving ADT, 84 prostate cancer patients not receiving ADT (prostate cancer controls), and 88 men without prostate cancer (healthy controls). Prostate cancer patients receiving ADT had either nonmetastatic or asymptomatic metastatic prostate cancer. Prostate cancer patients not receiving ADT had undergone prostatectomy and had no evidence of disease. Both control groups were matched by age and educational level; prostate cancer controls were further matched by time from prostate cancer diagnosis. The researchers used validated neuropsychological testing and self-reported depression and symptoms assessment to evaluate verbal/visual memory, attention, executive function, and cognitive reserve. Exploratory analyses of single-nucleotide polymorphisms also were prospectively assessed.

Because no differences in cognitive function were observed between the control groups, data from them were combined for analysis. Rates of impaired cognitive function were similar between the ADT group and the control groups at baseline. However, ADT patients demonstrated greater dysfunction over time, including a 70% increase in impaired performance at 6 months and a >50% increase at 12 months (P<0.05 for both).