Presentation Authors: Ming-Chieh Kuo, Chi-Shin Tseng, Chao-Yuan Huang, Cheng-Yu Huang*, Taipei City, Taiwan, Chao-Hsiang Chang, Chih-Hsin Muo, Chi-Jung Chung, Taichung City, Taiwan
Introduction: The aim of this study was to investigate the relationship between the use of androgen deprivation therapy (ADT) and the subsequent risk of cognitive decline in Asian men with prostate cancer (PC) by employing a nationwide population-based data set.
Methods: A population-based cohort of 24,464 men with newly diagnosed PC between 2,000 and 2008 was selected from the Taiwan National Health Insurance (NHI) Database. After excluding patients with ADT exposure, other malignancy, and diagnosis of the outcome of interests before the index date, 17,425 PC patients were included for final analysis. Patients were classified as ADT group (n=12,740) or non-ADT comparison group (n=4,685). A time-dependent exposure model was used, which allowed investigators to calculate the exposure period from the different usage of various kinds of ADT. The Multivariable Cox proportional hazard model with time-dependent covariates was used to estimate adjusted hazard ratios (HRs) of cognitive decline associated with different kinds of ADT treatment.
Results: Among 17,425 men with PC, there was a statistically significant association between ADT use and risk of overall cognitive decline (hazard ratio, HR, 1.51; 95% CI, 1.31-1.74). ADT users had a 1.83-fold risk of Parkinsonâ€™s disease and 1.38-fold risk of dementia correspondingly (95% CI = 1.44-2.34 and 1.17-1.63, respectively). After further investigating the subtypes of dementia, non-Alzheimer's dementia (non-AZD) rather than Alzheimerâ€™s dementia (AD) demonstrated a significant higher association with ADT use. Anti-androgen alone were associated with subsequent AD, non-AZD, and Parkinson disease. In addition, an increased risk of Parkinsonâ€™s disease was also observed in combined androgen blockade (CAB) group. The duration of ADT showed no association with cognitive dysfunction.
Conclusions: This population-based study demonstrated that antiandrogens alone was associated with a higher risk of overall cognitive dysfunction, overall dementia, and Parkinson disease. The risk of overall cognitive decline and Parkinsonâ€™s disease also appeared to be higher in CAB group. Different ADT therapies may have unequally impact on cognitive dysfunction.