The effect of androgen deprivation on mini-mental status examination in patients with biochemical recurrence of prostate cancer

Abstract

15592 Background: Androgen deprivation (AD) is a common treatment option for asymptomatic patients with biochemical recurrence of prostate cancer. Side effects such as sexual dysfunction, hot flashes, fatigue and gynecosmastia have been well documented. However, some of the side effects such as osteoporosis, insulin resistance, hyperglycemia, and anemia have only been recently recognized. The effects of AD on memory are not known. Aim: To determine if there is a decline in cognitive function(CF) in patients on AD using the modified MiniMental Status examination (MMSE). This test was chosen because it was simple, easy to administer and reproducible. Methods: We prospectively enrolled men with biochemical recurrence of prostate cancer prior to initiation of AD and monitored their MMSE at baseline, 2 ,and 4 months and while on AD (Mayo Clinic Jacksonville 8/2004- 9/2006). Results: 38 men were enrolled,however, only 20 men had at least 3 MMSE testing done. (5 withdrew consent, 13 had missing MMSE or lost to followup). The mean age was 68 years, mean baseline MMSE score was 27 and none had a clinical diagnosis of dementia or depression. Comparing the first MMSE and the 2nd MMSE score 19/20 patients had no decline of CF except for one patient who had a transient decline of 5 points in his MMSE score during a period of depression ,however, he had subsequent recovery of his score back to his normal baseline 27. Comparing the first and third MMSE score 20/20 patients had no decline of CF. The mean score change in MMSE score was -1 in 3 patients, 0 in 9 patients, +1 in 4 patients, +2 in 2 patients and +3 in 2 patients. There was no decline of 3 or more points in the mean score in any patient. Interestingly, 2 patients had an 3 point improvement of their MMSE score. We felt that it was secondary to being more familiar to the test process and not due to AD. Conclusions: There is no significant decline in MMSE score in men on AD at 2 and 4 months. MMSE might not be able to detect subtle changes in memory therefore, further study with more sensitive test to discriminate CF decline would be warranted and with longer followup cognitive impairement may be more evident. No significant financial relationships to disclose.