Testosterone-Lowering Drugs to Treat Prostate Cancer Can Increase Dementia RiskOct 24, 2016
A new study of records for more than nine thousand men with prostate cancer has shown that men who receive testosterone-lowering drugs to treat the cancer are twice as likely to develop dementia. Doctors have known for some time that testosterone can drive the growth of prostate tumors, Newsday reports. And they have known since the 1940s that androgen deprivation therapy - drugs that lower testosterone - can shrink tumors.
But a group of researchers primarily based at Stanford University has published an article in JAMA Oncology that said drugs that lower testosterone levels raise the risk of dementia about five years after treatment. Dr. Nigam Shah, a co-investigator on the research, said, "The risk is real and, depending on the prior dementia history of the patient, we may want to consider alternative treatment," according to Newsday.
Dr. Shah and Dr. Kevin Nead of the University of Pennsylvania, along with colleagues, analyzed the medical records of 9,272 men with prostate cancer; 1,862 were treated with androgen-deprivation therapy (ADT), according to Newsday. A recent study of actual patients reported in the New England Journal of Medicine drew the same conclusion: androgen-deprivation therapy raises the dementia risk.
But doctors on Long Island say the current study's design does not answer enough questions. "Androgen deprivation therapy has been around for a very long time," said Dr. Louis Kouvassi, who chairs the Arthur Smith Institute for Urology at Northwell Health in New Hyde Park. Dr. Deepak Kapoor, president of Advanced Urology Centers (on Long Island and in New York City), said the analysis does not take into account how androgen-deprivation medications are used.
"We use these drugs for people who have metastatic cancer," Kapoor explained. "These drugs should not be used as first-line agents. This is for people who have disease that has spread outside of the prostate." Without these drugs, Kapoor says, these patients would have very short survival, according to Newsday.
Androgen deprivation therapy involves one of several types of medications from the class of drugs known as luteinizing hormone-releasing hormone agonists, or LHRH agonists. These medications include Lupron, Eligard, Zoladex, Trelstar and Vantas.
This drug treatment is sometimes referred to as chemical castration because the testosterone decline is similar to the drop that occurs after surgical castration. Many patients dislike the drugs because of the side effects, such as loss of libido. The medications also raise levels of "bad" cholesterol.
The JAMA Oncology article showed that men who underwent androgen deprivation therapy for at least 12 months had the greatest absolute increase in dementia risk. Men ages 70 or older who underwent treatment were the least likely to avoid dementia, according to Newsday.
Dr. Raymond Sultan, a urologist at St. Francis Hospital in Roslyn, New York, said, "It's a good study. The numbers look impressive," but patients should talk to their urologists before drawing conclusions. Just because the statistics suggest androgen-deprivation therapy causes dementia, doesn't mean the drugs actually cause cognitive decline, Sultan said.
Dr. Paul Wright, chairman of neurology at North Shore University Hospital in Manhasset, New York said there are different mechanisms underlying different types of dementia. Patients can help prevent vascular dementia by modifying risk factors: they can control body weight and blood pressure and avoid smoking, for example.
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