ADT For Prostate Cancer & Dementia

A treatment method used since the 1940’s for men with prostate cancer may be linked with a higher risk of developing dementia.  New research published in JAMA Oncology has found men who have prostate cancer and have been treated with androgen deprivation therapy (ADT) had two times the likelihood of being diagnosed with dementia within five years from the time treatment was started when compared to men who were not treated with ADT.

“I have deep concerns of treating men with androgen deprivation therapy,” said Dr. David Samadi.  “There are multiple studies showing a vast list of side effects ADT can result in for men.  My concerns associated with ADT are increased risk for bone weakening, kidney damage, hip damage, impotence, cardiovascular disease, colorectal cancer, accelerated aging, weight gain, fatigue and depression. Now it looks like dementia can be added to this list.  This is simply not a good treatment method to be using.”

Researchers with the study analyzed medical records of 9,272 men with an average age of 67 being treated for prostate cancer between 1994-2013.  The number of men treated with ADT was 1,826.  The types of dementia assessed by the research team included Alzheimer’s disease, vascular dementia, and frontotemporal dementia.

Findings from the study showed men treated with ADT had an absolute dementia risk of 7.9 percent compared to 3.5 percent for men who did not receive ADT. Also found was that it didn’t matter what age the man was as the risk of dementia with ADT still doubled.  Men who were 70 and older and had used ADT were at a 13.7 percent greater risk for dementia than men who had not used the treatment who were at a 6.6 percent greater risk.  Men younger than 70 and treated with ADT had a 2.3 percent risk of dementia while men not treated with ADT had only a 1 percent risk for developing it.

The study was not able to determine the cause of why ADT appears to increase dementia risk. However, findings from previous studies suggest that testosterone appears to protect brain cells and when this hormone is reduced with ADT this removes an important method of defense against dementia.

ADT is used to suppress the amount of testosterone produced by the body with the goal being to shrink or slow the prostate tumor by starving cancer cells of the androgens that fuel its growth and spread.

There are three main situations in which ADT may be offered for men with prostate cancer according to the American Cancer Society.  One is if the surgery or radiation was not successful in treating the cancer, two, if the cancer has returned following surgery or radiation and third, it sometimes is recommended at the same time as radiation to improve treatment outcome.

On the one hand ADT has had significant benefits in increasing survival rates but at a price.  The same research team conducting this latest study had another study pointing to the same results of showing a link between ADT and Alzheimer’s disease.

“This new study should cause all doctors to pause before administering ADT,” stated Dr. Samadi.  It’s good we have more long-term cancer survivors than ever before but we need to be very careful of our choices of cancer therapies.  ADT is not automatically for all men.  Every doctor should have a thorough discussion with all men with prostate cancer of ADT’s risks and benefits.  It’s a fine line to walk and as a doctor, I want to advise and guide each man I see which direction to take concerning the use of ADT.