More often than not, doctors have to weigh a treatment with the potential side effects and risks to the patient’s health. Now results from a new a study could make the decision more challenging in regards to men’s reproductive and mental health. In particular, the study found that androgen deprivation therapy, a common treatment for prostate cancer, have more than the twice the risk of developing dementia later on.
The hormone testosterone is known to stimulate the growth and proliferation of prostate tumors. Thus, an effective and widely used anticancer technique is to lower the levels of this androgen. Indeed, androgen deprivation therapy (ADT) or androgen suppression therapy (AST) work to reduce testosterone and shrink the prostate tumor.
But the treatment that’s often the first-line of defense for men may exact a big price on their mental health.
In a retrospective study of more nearly 10,000 men with prostate cancer, a team at Stanford University found that 7.9 percent of men developed dementia within five years of treatment. This is more than twice the dementia risk for men not treated with testosterone-lowering drugs (at 3.5 percent).
The results support a previous study, also by the same authors, who found that ADT for prostate cancer was associated with Alzheimer’s disease. This time around, the team opted to cast for a wider association net: "So instead of looking for Alzheimer's and dementia separately, we decided to aggregate them into a higher-level category -- all dementias and cognitive decline," said Nigam Shah, associate professor of biomedical informatics research at Stanford, and the study’s senior author.
Although the study does not claim any causal effect between ADT and dementia, they say perhaps it’s a good idea to evaluate the need for ADT on an individual level. "The risk is real and, depending on the prior dementia history of the patient, we may want to consider alternative treatment,” said Shah.
Furthermore, Shah also pointed to a prostate cancer study recently published in the New England Journal of Medicine, in which researchers say some early stage prostate cancers may benefit more from active surveillance. The astonishing punch-line result – that invasive therapies don’t necessarily extend survival rate – gave pause to a doctor’s natural instincts to drug, cut, and treat.
In the same way, Shah hopes the current results will help patients and doctors make more informed decisions about the best course of action for themselves. In the same vein, the authors caution that patients already on ADT should evaluate their risks with their doctors before making any changes.
“Whether or not to use ADT is still a risk-benefit discussion with a physician,” said Kevin Nead, the study’s first author. “This study is important and urges us toward future research, but I don’t think it should impact clinical practice.”
Additional sources: Stanford University Medical Center
