Androgen deprivation in patients with prostate cancer could cause dementia …

/ Sebastian Kaulitzki, stockadobecom

Philadelphia – Men suffering from androgen deprivation as part of advanced prostate cancer treatment were more likely to develop Alzheimer's disease or other dementia during the course of their life. following years. This came in an analysis of the US SEERS cancer registry in JAMA Network open now (2019, doi: 10.1001 / jamanetworkopen.2019).

Androgen deprivation deprives prostate cancer of its most important growth factor, prolonging the patient's survival at an advanced stage. However, the absolute testosterone deficiency caused by the treatment has negative health consequences, which may include cognitive impairment. Androgen deficiency is thus suspected of promoting the development of dementia.

Ravishankar Jayadevappa of the Perelman School of Medicine in Philadelphia and colleagues evaluated data from the US Cancer Registry SEERS (surveillance, epidemiology and end results). The analysis is limited to 154,089 Medicare beneficiaries with prostate cancer and for whom the treatment is free.

62,330 men experienced androgen deprivation within 2 years of diagnosis. Jayadevappa compared the data with the remaining 91,759 patients without androgen deficiency. During a follow-up period of 8.3 years, 27,974 patients were diagnosed with dementia and 16,755 with Alzheimer's disease, which is not unusual given the Average age of patients about 75 years old.

Clinically relevant increase in Alzheimer's disease and dementia

Comparison of the two groups showed that androgen deprived patients were more often affected. The diagnosis of Alzheimer's disease was 13.1% versus 9.4% of patients without androgen deficiency. The difference of 3.7 percentage points was significant with a 95% confidence interval between 3.3 and 3.9%. Jayadevappa estimates a risk ratio of 1.14 (1.10-1.18) in a propensity analysis comparing only participants with similar characteristics (thus avoiding bias).

Dementia occurred in 21.6% of patients with androgen deficiency, compared to 15.8% of androgen-free patients, resulting in a difference of 5.8% (5.4 to 6.2%). %). The risk ratio was 1.20 (1.17 to 1.24) in the propensity analysis.

The results were therefore statistically significant and clinically relevant given the number of patients to inflict required (18 to 19) (17 to 19) of which one had also developed Alzheimer's disease as a result of treatment. The number of lesions needed for dementia was even worse with 10 (9.5 to 11 patients).

Despite a dose-response relationship, the study can not conclusively prove that testosterone withdrawal is responsible for dementia and Alzheimer's disease. If suspicions are confirmed, however, nothing will change for the patients concerned. There is currently no alternative to androgen removal.

It would be interesting if the type of androgen withdrawal has an impact on the risk. Previously, treatment was surgically performed by removing the testicles. Today, pharmacotherapy is generally preferred. © heat / Good medical