Impact of Androgen Deprivation Therapy on Self-Reported Cognitive Function in Men with Prostate Cancer

Shireen Marzouk; Gary Naglie; George Tomlinson; Sarah Duff Canning; Henriette Breunis; Narhari Timilshina; Shabbir M H Alibhai

doi:10.1016/j.juro.2018.02.073

Impact of Androgen Deprivation Therapy on Self-Reported Cognitive Function in Men with Prostate Cancer

J Urol. 2018 Aug;200(2):327-334. doi: 10.1016/j.juro.2018.02.073. Epub 2018 Mar 1.

Authors

Shireen Marzouk¹, Gary Naglie², George Tomlinson³, Sarah Duff Canning⁴, Henriette Breunis¹, Narhari Timilshina¹, Shabbir M H Alibhai⁵

Affiliations

¹ Department of Medicine, University Health Network, Toronto, Ontario, Canada.
² Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Neurosciences Program, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: shabbir.alibhai@uhn.ca.

PMID: 29477720
DOI: 10.1016/j.juro.2018.02.073

Abstract

Purpose: Although androgen deprivation therapy is widely used to treat prostate cancer, its effects on cognitive function are unclear. To our knowledge no prior report has examined the impact of androgen deprivation therapy on self-reported cognitive function.

Materials and methods: Three groups of men 50 years old or older who were matched on age and education were enrolled in the study, including 81 with prostate cancer starting on continuous androgen deprivation therapy, 84 controls with prostate cancer not receiving androgen deprivation therapy and 85 healthy controls. Two scales from the FACT-Cog (Functional Assessment of Cancer Therapy-Cognitive subscale) version 3 were used to assess self-reported cognitive function. Changes in cognitive scores with time were analyzed by 2 approaches, including 1) multivariable regression and 2) calculation of the proportion of subjects per group with a decrease of 1 SD or more. Multivariable regression was applied to assess predictors of a decline in self-reported cognitive function. We also examined relationships between the FACT-Cog and a neuropsychological battery of 15 tests.

Results: Mean participant age was 69 years (range 50 to 87). The mean educational level was 15 years (range 8 to 24). FACT-Cog scores were similar at baseline across the cohorts. Neither analytical approach revealed that androgen deprivation therapy was associated with changes in self-reported cognitive function on either FACT-Cog scale. Mood and fatigue correlated with changes in self-reported cognitive function. The relationship between self-reported and objective cognitive measures was weak (maximum Spearman correlation coefficient 0.14) and only 2 of 30 correlations were statistically significant.

Conclusions: A total of 12 months of androgen deprivation therapy were not associated with self-reported cognitive function changes in older men with nonmetastatic prostate cancer.

Keywords: androgen antagonists; cognitive dysfunction; prostatic neoplasms; quality of life; surveys and questionnaires.

MeSH terms

Affect / drug effects
Age Factors
Aged
Aged, 80 and over
Androgen Antagonists / adverse effects*
Antineoplastic Agents, Hormonal / adverse effects*
Cognition / drug effects*
Cohort Studies
Educational Status
Fatigue / chemically induced
Fatigue / psychology
Humans
Male
Middle Aged
Neuropsychological Tests
Prostatic Neoplasms / drug therapy*
Quality of Life
Self Report / statistics & numerical data*
Surveys and Questionnaires

Substances

Androgen Antagonists
Antineoplastic Agents, Hormonal