ADT Associated With Neurocognitive Risks

By Patrick Daly - Last Updated: December 2, 2022

Androgen deprivation therapy (ADT) alongside external beam radiation therapy is a treatment used in patients with localized prostate cancer; however, ADT may be linked to long-term neurocognitive consequences. According to a meta-analysis presented at the 23rd Annual Meeting of the Society of Urologic Oncology, patients with prostate cancer who received ADT showed a significantly increased risk of dementia, Alzheimer disease (AD), Parkinson disease (PD), and depression.

The researchers’ systematic review identified and included 22 studies from the PubMed, Embase, Scopus, and Google Scholar databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The pooled cohort comprised 2,413,131 patients with prostate cancer. Of those patients, 846,394 received ADT and 1,187,153 did not.

ADT Appears to Significantly Increase Neurocognitive Risk

Based on their analysis, researchers established that recipients of ADT had increased risk for:

All-cause dementia (hazard ratio [HR], 1.21; 95% CI, 1.11-1.31; P<.00001)
AD (HR, 1.26; 95% CI, 1.10-1.43; P=.0007)
PD (HR, 1.57; 95% CI, 1.31-1.88; P<.00001)
Depression (HR, 1.87; 95% CI, 1.74-2.00; P<.00001)

The authors noted that risk for vascular-cause dementia was increased but not by a statistically significant amount (HR, 1.30; 95% CI, 0.97-1.73; P=.08).

They also found increased risk for all-cause dementia in 3 subgroups based on ADT type: orchiectomy (HR, 1.36; 95% CI, 1.17-1.59; P<.0001), antiandrogens (HR, 1.15; 95% CI, 1.31-1.88; P<.00001), and gonadotropin-releasing hormone agonists (HR, 1.11; 95% CI, 1.05-1.17; P=.0002). Finally, patients who received ADT for less than 6 to 12 months had increased all-cause dementia risk (HR, 1.10; 95% CI, 1.02-1.20; P<.0001) that potentially grew at longer durations (HR, 1.125; 95% CI, 1.12-1.39; P<.0001).

In short, the meta-analysis showed an increased risk of dementia, AD, PD, and depression with ADT in patients with prostate cancer. “Further studies are needed to better characterize the interaction of ADT, aging, and the underlying prostatic malignancy,” the authors concluded.