In a recent study, researchers from Penn Medicine find a common hormone therapy to treat prostate cancer may double a man’s risk of dementia.
This suggests a broader neurocognitive risk associated with the testosterone-lowering therapy.
Recent research has discovered a dramatic link between Alzheimer’s disease and androgen deprivation therapy (ADT).
Androgens (male hormones) normally play a key role in stimulating prostate cell growth.
Thus, therapies that suppress androgen production or activity are often used in treating prostate tumors.
ADT has become a mainstay of treatment for prostate cancer since the 1940s currently used in over a half million men in the United States.
However, drastically reducing androgen activity can have adverse side-effects.
Studies have found associations between low testosterone levels and obesity, diabetes, high blood pressure, and heart disease, which are also known risk factors for dementia.
Research in recent years also has linked ADT and low testosterone to cognitive deficits.
It has shown that men with Alzheimer’s tend to have lower testosterone levels, compared to men of the same age who don’t have the disease.
Nevertheless, it is currently unknown if ADT may contribute to the risk of dementia more broadly.
In the study, the analysis compared the medical records of almost 9,500 prostate cancer patients who received ADT vs. those who did not strongly support that possibility.
They used a novel and sophisticated “text-processing” method to analyze electronic medical records from patients treated at an academic medical center from 1994 to 2013, with a median follow-up of 3.4 years.
The team identified 9,277 men with prostate cancer with a mean age of 66.9 years, including 1,826 men who received ADT.
They showed that the ADT group, compared to the control group, had significantly more cases of dementia in the years following the initiation of ADT.
The increased risk of dementia was 4.4% at five years: 7.9% among those who received ADT vs 3.5% in those who did not, which is more than double the risk.
The researchers also found a “dose-response effect”: Patients who had been receiving ADT for at least 12 months had the greatest risk of dementia.
In addition, the probability of developing dementia at five years was 13.7% in men over 70 who had ADT vs. 6.6% in men over 70 who did not.
For men younger than 70, it was 2.3% in those who had the therapy vs. 1% for those who did not.
The researchers suggest that testosterone has a general protective effect on brain cells so that lowering testosterone would leave the brain less able to resist the processes leading to dementia and Alzheimer’s.
The study is published in JAMA Oncology.
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Source: JAMA Oncology.