Association Between ADT for Prostate Cancer and Diagnosis of Alzheimer Disease or Dementia in Older Patients
In a report published by Jayadevappa et al in JAMA Network Open, researchers found that among older patients with prostate cancer, treatment with androgen-deprivation therapy (ADT) was associated with a subsequent diagnosis of Alzheimer disease or dementia over a follow-up period of at least 10 years.
Methods
Researchers examined data from 154,089 elderly men with newly diagnosed prostate cancer from the Surveillance, Epidemiology, and End Results–Medicare linked database. Approximately 62,000 patients receiving ADT within 2 years of diagnosis were identified. Diagnosis occurred between 1996 and 2003, and analyses were conducted in 2018. Mean follow-up was 8.3 years, and survival analysis was used to determine association between ADT treatment and diagnosis with Alzheimer disease or dementia.
Findings
Exposure to ADT vs no exposure to ADT was associated with Alzheimer disease (13.1% vs 9.4%; hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10–1.18) and dementia (21.6% vs 15.8%; HR = 1.20, 95% CI = 1.17–1.2) diagnosis. For Alzheimer disease, the hazard ratio for one to four doses of ADT was 1.19, and for five to eight doses, was 1.28. For dementia, the hazard ratio for one to four doses was 1.19, and for five to eight doses, was 1.24. For more than eight doses of ADT, the hazard ratio for Alzheimer disease was 1.25 and was 1.21 for dementia. The number needed to harm was 18 patients for Alzheimer disease and 10 patients for dementia.
The authors concluded, “In summary, our population-based study spanning 10 years or more following the diagnosis of prostate cancer shows that exposure to ADT was associated with increased hazard of both Alzheimer disease and dementia among elderly fee-for-service Medicare beneficiaries with prostate cancer. The list of effective ADT agents has recently grown with the addition of androgen synthesis inhibitors and second-generation antiandrogens. Furthermore, data are accumulating for the use of such agents earlier in the course of disease progression. Our results suggest that clinicians need to carefully weigh the long-term risks and benefits of exposure to ADT in patients with a prolonged life expectancy and stratify patients based on dementia risk prior to ADT initiation.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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®.
