As reported by Baik et al in the Journal of Clinical Oncology, Medicare patients who received androgen-deprivation therapy for prostate cancer do not appear to be at increased risk for Alzheimer’s disease and may have an extremely small increased risk for dementia.
The study involved 1,238,879 Medicare beneficiaries aged ≥ 67 years from the Medicare claims database who developed prostate cancer between 2001 and 2014. Of them, 440,129 (35%) received androgen-deprivation therapy. Separate analyses were performed for risks for diagnoses of Alzheimer’s disease and dementia according to androgen-deprivation therapy use.
Risk of Alzheimer’s Disease and Dementia
Among all patients, 8.9% developed Alzheimer’s disease, 18.8% developed dementia, and 26% to 33% died without developing either disease during approximately 7 million years of follow-up. In the Alzheimer’s disease analysis, for androgen-deprivation therapy recipients vs nonrecipients, crude rates per 1,000 patient-years were 17.0 vs 15.5 for Alzheimer’s disease and 73.0 vs 51.6 for all-cause mortality. In an unadjusted analysis of dementia, the crude rates for dementia were 38.5 vs 32.9 per 1,000 patient-years. In competing risks analyses adjusting for other cancer treatments and covariates, androgen-deprivation therapy was not associated with an increased risk of Alzheimer’s disease (subdistribution hazard ratio [SHR] = 0.98, 95% confidence interval [CI] = 0.97–0.99) and was associated with a 1% increased risk of dementia (SHR = 1.01, 95% CI =1.01–1.02). Patients receiving androgen-deprivation therapy were more likely vs nonrecipients to die before progression to Alzheimer’s disease (SHR = 1.24, 95% CI = 1.23–1.24) or dementia (SHR = 1.26, 95% CI = 1.25–1.26).
The investigators concluded: “These data suggest that [androgen-deprivation therapy] treatment has no hazard for [Alzheimer’s disease] and no meaningful hazard for dementia among men age 67 years or older who are enrolled in Medicare.”
The study was supported by the Intramural Research Program of the National Library of Medicine, National Institutes of Health.
Clement Joseph McDonald, MD, of the National Library of Medicine, National Institutes of Health, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.