Prostate Cancer Treatment Could Impair Men's Thinking

TUESDAY July 29, 2008 -- Men undergoing hormone deprivation therapy to keep prostate cancer at bay may experience memory loss and have trouble concentrating, a new study finds.

Testosterone is thought to help spur prostate cancer. So, androgen depletion therapy has been used for many years to treat the disease. By reducing the level of testosterone, the treatment helps to slow the growth of prostate cancer cells.

However, "androgen depletion therapy can potentially have some subtle, adverse cognitive effects," said lead researcher Christian J. Nelson, from the department of psychiatry and behavioral sciences at Memorial Sloan-Kettering Cancer Center in New York City.

These effects include difficulty in remembering and multi-tasking, Nelson said. "These men might not be thinking as quickly as they used to," he said. "They may find it more difficult to hold several pieces of information in their mind at one time."

The report was published in the July 28 online edition of Cancer.

For the study, Nelson's group reviewed a variety of studies in both animals and people that looked at the effects of androgen depletion therapy on cognition. They found that, depending on the study, between 47 percent and 69 percent of men treated with a hormonal approach did experience some decline in at least one area of cognition.

Troubling as the cognitive effects might seem, men should not seek to discontinue their therapy, Nelson said. "Treating the disease is much more important than these subtle cognitive effects," he said.

It's not known whether these effects are a direct result of hormone depletion or whether they are tied to the other side effects of hormone therapy. Those side effects include hot flashes, fatigue and anemia.

The research in this area is new, and not much is known about the full extent of cognitive problems brought on by androgen depletion, Nelson said. As for specific advice, Nelson noted there is no standard recommendation, but a few common sense tips may help.

"As men start this therapy, it is important to monitor them to see if they are having any of these effects," Nelson said. "If you are having difficulty with memory, make sure you are writing things down more. If you are having difficulty with multi-tasking, try simple things like focusing on one thing at a time," he said.

It is possible that when hormone therapy is stopped, these adverse cognitive effects go away, Nelson added.

Dr. Durado Brooks, director of prostate and colorectal cancers at the American Cancer Society, said the study highlights a largely ignored side effect of androgen depletion therapy.

Recent studies have also shown an increased risk of fracture and other conditions associated with the treatment, he said.

"There is a study that suggests that cardiovascular death rates may be higher among men undergoing this therapy. There is clear evidence that there is an increase in metabolic syndrome, which is associated with coronary artery disease and diabetes," Brooks said.

Moreover, androgen depletion therapy continues to be offered in situations where its benefits are not clear, Brooke said. Androgen depletion therapy may not be appropriate for treating early disease and should only be used in cases of advanced prostate cancer, he said.

"Many men are being treated with androgen depletion therapy for localized disease," Brooks said. "A study that was published just last month shows there is no survival advantage for most men in that situation," he said. "Men need to decide whether the potential benefit outweighs the harm of the therapy for them."

Posted: July 2008


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