(UroToday.com) The 2023 ASCO annual meeting included a prostate cancer session, featuring a presentation by Dr. Dina Elantably discussing clinical outcomes from real-world data assessing ADT and risk of dementia in patients with prostate cancer. For decades, ADT has been the cornerstone for the treatment advanced prostate cancer. However, based on several studies in the past few years, there has been growing concerns regarding increased risk of depression and dementia with ADT.1 Not all data has aligned to date, as previous studies of dementia risk following ADT have been controversial and inconclusive.
For this study, data was collected from the TriNetX electronic health record database, which includes over 89 million patients from 56 healthcare systems in the United States. Dr. Elantably and colleagues identified males over the age 50 years who were diagnosed with any stage of prostate cancer between 2005 and 2022. Patients receiving ADT were 1:1 propensity score-matched with non-exposed controls for demographics and risk factors for: (i) dementia, (ii) diabetes mellitus, (iii) hypertension, (iv) hyperlipidemia, (v) obesity, (vi) depression, (vii) cerebrovascular disease, (viii) tobacco use, (ix) alcohol dependence, and (x) benzodiazepine use. Of note, patients with prior dementia, stroke, or TIA were excluded.
In this cohort of 627,025 men with prostate cancer, 73,933 patients (mean age of 70.8 years) received ADT and 57,005 patients (mean age of 70.4 years) did not receive ADT. ADT exposure was associated with a diagnosis of dementia (Alzheimer’s disease, vascular dementia, or unspecified dementia): HR 1.60 (95% CI 1.49, 1.73). Compared to the non-ADT group, exposure to ADT was associated with a higher risk of dementia among whites (78.6% vs. 77.7%, p <0.001), whereas there was no significant difference among African Americans. The risk of dementia with different ADT regimens is highlighted in the following table, notably highest with GnRH antagonists (HR 1.92, 95% CI 1.47-2.52):
Subgroup analysis by subtype of dementia is highlighted in the following table, notably highest among those with unspecified dementia (HR 1.61, 95% CI 1.48-1.76):
Dr. Elantably concluded his presentation discussing clinical outcomes from real-world data assessing ADT and risk of dementia in patients with prostate cancer with the following take-home points:
- This is the largest real-world study describing the association between ADT and the risk of dementia, including over 627,025 men with prostate cancer
- The risk of dementia was significantly higher in patients on ADT, with a 60% increased risk
- The highest risk was witnessed with GnRH antagonists (ie. degarelix), with a 92% increased risk
- Of note, the increased risk of dementia in ADT groups was observed only among whites but not in African Americans
- Possible causes of this discrepancy include socioeconomic disparities, bias that resulted in underdiagnosis, or biological differences
Presented by: Dina Elantably, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, Fri, June 2 – Tues, June 6, 2023.
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