Once men are diagnosed with prostate cancer, they are often offered treatments that lower testosterone, as testosterone fuels the cancer’s growth.
The treatment, called androgen-deprivation therapy, typically impairs sexual function and can harm bones and cardiovascular health.
Now, a new study published on JAMA Network Open suggests this approach may also increase the odds of developing Alzheimer’s disease and other types of dementia.
“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 study author Ravishankar Jayadevappa, research associate professor of geriatrics at the University of Pennsylvania’s Perelman School of Medicine.
This leaves health professionals with a difficult decision when treating prostate cancer. The treatment in question – androgen-deprivation therapy – in theory, is the best way to treat prostate cancer, says urology specialist Dr Elizabeth Kavaler, but the new data means “tough decision-making” for patients and their physicians.
“Most of us are becoming as afraid of getting Alzheimer’s as we are of getting cancer,” said Dr Kavaler.
“When a study pits one debilitating condition against another, it instils fear in patients.”
Researchers reviewed and analysed US National Cancer Institute data on more than 154,000 prostate cancer patients diagnosed between 1996 and 2003. About 62,000 received hormone-depleting therapy within two years of their diagnosis, while about 92,000 did not.
In total, 13 per cent of those who had received the therapy went on to develop Alzheimer’s disease, compared to nine per cent who hadn’t received the treatment. In terms of other forms of dementia, 22 per cent of those who had received the therapy received such a diagnosis, compared with 16 per cent of those who had not undergone therapy.
While androgen-deprivation therapy is an effective means of slowing the progress of prostate cancers, it is now more commonly used in cases of advanced disease, or when the chance of a tumour recurrence is high.
The study findings may be a cause for concern for prostate cancer patients, but health experts say they warrant further analysis, because, while there is a loose association between hormonal treatment and raised odds for dementia, the study does not prove cause and effect.
Men receiving hormonal therapy tended to be “older, sicker and had more advanced prostate cancer,” said Dr Maria Torroella Carney, chief of geriatric and palliative medicine at Northwell Health in New Hyde Park, New York.
The men who received the therapy may also have lived longer, which would also contribute to their odds of dementia, Dr Carney explained.
“I think we need to look at these patients on an individual level,” said study co-author Dr Thomas Guzzo.
“Certainly, there are patients who need hormonal therapy and benefit from it greatly. There are others where the evidence is less clear, and in these patients, we should 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.”
Have you had androgen-deprivation therapy? Or do you know someone who has? Is there any evidence that it led to dementia or Alzheimer’s?
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