ADT for prostate cancer does not negatively impact cognition
MedWire News: Prostate cancer patients treated with androgen deprivation therapy (ADT) do not experience a worsening of cognition after treatment, show the results of a US study.
Supriya Gupta Mohile, from the James Wilmot Cancer Center in Rochester, New York, and colleagues hypothesized that elderly patients who are initiated on ADT may have a high prevalence of baseline cognitive dysfunction and may be at risk for further deterioration with such treatment.
However, they found no adverse changes in cognitive functioning following ADT initiation among the 21 prostate cancer patients in their study, despite some having lower-than-expected baseline functioning.
Study participants were aged a median 71 years, and underwent extensive neuropsychological testing before ADT, and 6 months after treatment began.
Attention, language, visuospatial planning, verbal memory, visual memory, and motor processing were measured, as well as levels of patient depression and anxiety. Impaired performance on a test was defined as scoring more than 1.5 standard deviations below the age- and education-adjusted population reference mean.
In total, 52% (n=16) of patients had impaired performance on a verbal or visual delayed memory measure at baseline. Furthermore, 45% of patients met the criteria for mild cognitive impairment, scoring below expectation on at least one standardized measure of cognitive function, typically, memory tasks.
At 6 months, no significant changes were observed for the group as a whole on any cognitive measures apart from motor speed, which was slightly faster, at 43 versus 40 finger taps using the dominant hand, and 40 versus 39 using the non-dominant hand, respectively.
The researchers used the Reliable Change Index to determine whether the magnitude of change for a patient was statistically reliable, ie, beyond that attributable to measurement error.
The RCI showed that, overall, none of the men's cognitive measures declined, while 14% significantly improved and 57% had a mix of decline and improvement on one or more measures. The biggest improvement (58%) was observed in visuospatial functioning.
"Future studies should document the pre-treatment cognitive status of older prostate cancer patients and subsequent vulnerability after hormonal interventions," conclude Gupta Mohile et al in Critial Reviews in Oncology and Hematology.
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By Sarah Guy