Impact of 12 months of androgen-deprivation therapy (ADT) on cognitive function in men with nonmetastatic prostate cancer (PC): A matched cohort study.

Abstract

9027 Background: ADT is used to treat almost 50% of current PC patients. Despite slowing disease progression and prolonging survival, ADT is associated with numerous side effects. However, the impact of ADT on cognitive function remains uncertain, limited by small published studies and inconsistent findings. Methods: Men age 50 or older with non-metastatic prostate cancer (PC) were included. Three separate groups matched on age and education were tested longitudinally for cognitive function; PC patients starting continuous ADT (n = 79), PC patients not receiving ADT (PC controls, n = 83), and healthy controls (n = 82). A battery of 12 neuropsychological tests, examining 8 cognitive domains, was administered at baseline (prior to ADT treatment), 6 months, and 12 months later. Mean scores at baseline were compared using ANCOVA, and change scores between baseline and both 6 months and 12 months were analyzed using multivariable linear regression models. In an alternate analysis, the proportion of subjects per group with 1-SD or greater cognitive changes were compared. Results: The mean age and education level of the patients overall was 69.2 years (range 50-87) and 15.4 years (range 8-24), respectively. All 3 cohorts had similar adjusted cognitive scores at baseline other than in 1 test of working memory. Adjusted for age and education, ADT use was not associated with significant changes in the domains of Attention and Processing Speed, Verbal Fluency, Verbal Memory, Visual Memory, or Executive Functions of Cognitive Flexibility from baseline to either 6 months (all p<0.05) or 12 months (all p<0.05). 1 test of Immediate Memory (p = 0.033), 1 test of Working Memory (p = 0.037), and 1 test of Visuo-Spatial Ability (p = 0.029) were worse among ADT users than controls at 12 months, but these findings were not confirmed by other domain-specific cognitive tests or in analyses of 1-SD change per group. Conclusions: In the largest study to date, there is no consistent evidence of decline in cognitive function with ADT use for 12 months across 8 cognitive domains compared with controls. No significant financial relationships to disclose.