Abstract
BackgroundDespite a lack of consensus regarding effectiveness, androgen deprivation therapy (ADT) is a common treatment for non-metastatic, low-risk prostate cancer. To examine a particular clinical concern regarding the possible impact of ADT on cognition, the current study combined neuropsychological testing with functional magnetic resonance imaging (fMRI) to assess both brain activation during cognitive performance as well as the integrity of brain connectivity.MethodsIn a prospective observational cohort analysis of men with non-metastatic prostate cancer at a Veterans Affairs medical center, patients receiving ADT were compared with patients not receiving ADT at baseline and at 6 months. Assessments included fMRI, the N-back task (for working memory), the stop-signal task (for cognitive control), and a quality of life questionnaire.ResultsAmong 36 patients enrolled (18 in each group), 30 completed study evaluations (15 in each group); 5 withdrew participation and 1 died. Results for the N-back task, stop-signal task, and quality of life were similar at 6 months vs. baseline in each group. In contrast, statistically significant associations were found between ADT use (vs. non use) and decreased medial prefrontal cortical activation during cognitive control, as well as decreased connectivity between the medial prefrontal cortex and other regions involved with cognitive control.ConclusionsAlthough ADT for 6 months did not affect selected tests of cognitive function, brain activations during cognitive control and functional brain connectivity were impaired on fMRI. The long-term clinical implications of these changes are not known and warrant future study.
Highlights
Despite a lack of consensus regarding effectiveness, androgen deprivation therapy (ADT) is a common treatment for non-metastatic, low-risk prostate cancer
Our objective was to evaluate the impact of ADT on cognition using functional magnetic resonance imaging (fMRI) to study brain activations during a cognitive task and at rest, the stop-signal-task to study cognitive control, and the N-back test to study working memory
Patients with non-metastatic prostate cancer who had never been treated with ADT were evaluated as potential controls, with matching based on age and level of education
Summary
Despite a lack of consensus regarding effectiveness, androgen deprivation therapy (ADT) is a common treatment for non-metastatic, low-risk prostate cancer. To examine a particular clinical concern regarding the possible impact of ADT on cognition, the current study combined neuropsychological testing with functional magnetic resonance imaging (fMRI) to assess both brain activation during cognitive performance as well as the integrity of brain connectivity. Functional magnetic resonance imaging (fMRI) provides a non-invasive method to assess brain activations during cognitive performance as well as the integrity of regional functional connectivities at rest. Studies using fMRI have demonstrated etiology-specific changes in regional brain activations in patients with neurological or psychiatric conditions, even when they did not score differently from control individuals in neurocognitive tasks [17,18,19]. FMRI provides a more sensitive measure of brain functioning than neurocognitive testing alone
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
