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When the Research is Contradictory: Prostate Cancer Treatment and Dementia

When it comes to researching a medical diagnosis or condition, the overabundance of information on the Internet is both a blessing and a curse. The World Wide Web contains more blogs, chat rooms and medical journals than anyone could ever read in a lifetime.

Too much information may only create more fear of the unknown, as most readers don’t have the medical expertise to decipher the nitty gritty details of scientific data. To add to the confusion, breaking research conducted by one group of physicians may be contradicted immediately by another.

For example, an article published in JAMA Oncology in January addressed a potential link between androgen deprivation therapy (ADT) in prostate cancer patients and increased cases of dementia. In the exact same month, research published in the Journal of Clinical Oncology reported that there was no link between the treatment and dementia. Authors of both studies recommended additional research to further confirm their findings.

If you or a loved one is facing prostate cancer and considering ADT as part of a treatment plan, what are you to make of the conflicting research and technical data?

Pat Fulgham, M.D., urologist on the medical staff and medical director of surgical oncology services at Texas Health Dallas, provided an explanation of the specific issue at hand.

“Aging, in general, is associated with lower testosterone levels,” he explains. “There is a decrease in cognitive ability in older men independent of prostate cancer and independent of their testosterone status. Therefore, it is not surprising that older men on androgen deprivation therapy (ADT) may experience a decline in cognitive function. The data that claim to show a causative relationship between hormone therapy and Alzheimer’s disease is not supported by other large studies of older men on ADT, and most recently in an article published in the Journal of Clinical Oncology.”

The authors of the article referenced by Fulgham did address the fact that their findings were contradictory to the other recent study. They write that while ADT is the go-to treatment for patients with advanced prostate cancer, there are known adverse side effects, with dementia being the current major concern. Their article addressed the three observational studies investigating the link between ADT and cognitive impairment, as well as researchers’ mixed reports and potential reasons for the contradictory findings due to differences in how the research was conducted.

At the end of the day, patients are wise to keep up on the research surrounding their conditions, but should defer to their doctors about any potential changes to the recommended therapies.

Fulgham explains that if treatments do lead to known potential brain and behavioral changes, a prostate cancer patient’s family members should notify his physician for further follow-up.

“What I tell my patients about ADT is that it may cause changes in mood, which can include depression, anxiety, and anger in some men,” he says. “I warn the family that if they notice changes in mood or memory, they should contact me so I can refer them to their primary care physician or a neurologist for further evaluation.

“There are some patients for whom the side effects of ADT are so bothersome that the therapy needs to be stopped and other options for treatment considered. Happily, we now have second- and third-line therapies that can be used in patients who cannot tolerate ADT.”

Fulgham says that in addition to ADT or other medical treatments, there are tried-and-true ways to encourage healing and improved health.

“General consideration for maintaining overall health has also been shown to preserve and protect cognitive function,” he explains. “Regular exercise, a healthful diet, and continued care for physical and mental challenges such as exercise and problem solving, may be helpful in forestalling ADT.  I encourage my patients to talk with their primary care physicians about heart health, cholesterol management, and glucose management when starting ADT and how ADT may interact with their other medications.”

Texas Health offers a full continuum of cancer care, including diagnosis, treatment, rehabilitation, education, support, prevention, research, and long-term follow-up care for patients.

To find out about the cancer care options available at your closest Texas Health hospital, visit: https://www.texashealth.org/Pages/Services/Cancer.aspx.

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