ASCO GU 2017: Adverse effects of ADT on cognitive function and dementia for men with prostate cancer: A meta-analysis and systematic review

Orlando, Florida USA (UroToday.com) Androgen deprivation therapy (ADT) is a common treatment for metastatic hormone-sensitive prostate cancer. Over 500,000 men are current on an ADT regimen. However, ADT does have some notable side-effects. Long-term risk of dementia is one of the more controversial side effects attributed to ADT, and current reports suggest variable influence of ADT on cognitive functioning. The objective of this study was to provide a systematic review and meta-analysis of overall cognitive impairment in men receiving ADT for prostate cancer.

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were applied to a literature review through December 2016. International cognition and cancer task force (ICCTF) criteria were utilized to determine impaired cognitive performance for controlled intervention studies. Studies not using ICCTF were excluded.

Eight studies of a total two hundred twenty-one identified met strict inclusion criteria and were included in the meta-analysis. The hazard ratio of cognitive decline for case-controlled studies (n=6) was 1.37 (95% CI 1.06-1.77, p = 0.02). For controlled studies (n=2) the hazard ratio of cognitive decline was 1.57 (95% CI 0.50-4.92, p = 0.44).

The authors concluded that the impact of ADT on cognitive decline was unclear based on controlled intervention studies. However, in case-controlled studies, there appeared to be a negative impact of ADT on cognitive functioning. The authors cautioned not to over-interpret these data in light of their retrospective nature and risk of bias. Future prospective studies are needed to better understand the relationship between ADT and long term risk of dementia.

First Author: Maxine Sun, Brigham and Women’s Hospital, Harvard Medical School

Written By: Benjamin T. Ristau, M.D., Fox Chase Cancer Center

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA

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