ADT Associated with Alzheimer's...

"For those who like to worry, enjoy this new material..."
Lol Gary!

What is the purpose of such a study - except, as Gary indicated, to maybe give some guys more unnecessary worries. The vast majority of guys on ADT have few options, other than dying. Wouldn't the resources for such studies be better spent elsewhere?

Maybe I'm missing a significant point.

Gary,
Maybe you misinterpret my post - but maybe not. Your text I quoted I found to be quite humorous. Maybe you didn't intend it as such.

My criticism is for the value of the study, not for you posting it.

Anyway, the bottom line is as you say, avoid what you can, and don't stress on what you can't.

The study is in JAMA, July 3, 2019: Association between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men with Prostate Cancer. R. Jayadevappa, S. Chhatre, B. Malkowicz et al. Google ADT alzheimer and it's the fourth hit. I tried creating a link to the URL and it wouldn't work for some reason.

The article breaks down risk by dose of ADT: 1-4 doses, 5-8 doses, and >8 doses, but I don't see a definition of "dose" -- if anyone can find it, please help me out. Also, not clear what regimen of ADT qualified. The usual caveats about retrospective studies.

I happened to see an MO for the first time yesterday, and he mentioned this study to me. He seemed glad I stopped ADT after one year. ... MO doesn't mean bad news on my end, btw. The Saipan hospital just hired an MO, for the first time in my 12 years here, and my PCP referred me to him for routine followups. Seemed a good idea, and he made a favorable impression on me. All's well (pending results of yesterday's blood draw, of course).

https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-androgen-deprivation-therapy-for-prostate-cancer-and-risk-of-alzheimers-and-dementia/

It's not useless research. In some cases of salvage radiation, ADT is optional. If someone is on the fence, perhaps this knowledge would influence him to decline ADT. That would especially be the case for guys with a family history of Alzheimer's.

Post Edited (fiddlecanoe) : 8/20/2019 3:39:50 PM (GMT-6)

Interesting study. However, I don't believe anyone should be deterred from going the ADT therapy route based on the higher hazard of Alzheimer's disease/dementia alone. The researchers did identify some key elements that in and of themselves can be linked to a higher risk of developing dementia or Alzheimer's - i.e. those who received ADT were older at diagnosis of prostate cancer and men receiving ADT were more likely to have at least 1 comorbidity and have more aggressive cancer than those not receiving ADT. Also noted - among the surgery group, ADT use had a lower hazard of diagnosis of Alzheimer disease and a higher hazard of dementia, in the radiation and chemotherapy groups, the association between exposure to ADT and diagnosis of Alzheimer disease (or dementia) was higher. There are a lot of confounding variables within the population studied. The study tends to show a possible link between ADT and treatment, causality isn't established. The older we get the more likely it is that we will develop dementia or Alzheimer's (the dementia group in this study was actually larger than the Alzheimer's group). Age, other health conditions/comorbidities, etc., have ties to the development of organic brain disease.

A key paragraph to note: While our study suggests an association between ADT and subsequent dementia diagnosis, we were unable to further investigate possible biological mechanisms of this association. It is important to note that dementia may have a latency period of 1 decade or more prior to cognitive manifestations, with some cerebrospinal fluid, serum, and neuroimaging biomarkers present many years before diagnosis. Hence, it is possible that ADT has a modifying or augmenting, rather than de novo, effect on development of dementia. Further work could be done to characterize individuals undergoing ADT who are at high risk of developing earlier dementia.

To sum up my overall feeling as a spouse, would I prefer that my husband not take ADT due to the possible risk and die of PCa with his mind intact, or live with me into our later years when we both might develop dementia/Alzheimer's anyway? That's a pretty easy question for me.

Nytngale said...

.....To sum up my overall feeling as a spouse, would I prefer that my husband not take ADT due to the possible risk and die of PCa with his mind intact, or live with me into our later years when we both might develop dementia/Alzheimer's anyway? That's a pretty easy question for me.

While the question is easy, the answer is both difficult and obscure. The reliable statistics on the use and benefits of ADT hormones to improve radiotherapy treatment are neither convincing or straight forward. At the same time, the side effects are alarming. There is a wide, and increasing, difference of opinions among radiation oncologists, even the best of them.

Sometimes we don't have a choice, but most of the time we do, so thread very carefully.

May you and your husband continue to enjoy a long life together, Nytngale.

mattam said...
"Sometimes we don't have a choice, but most of the time we do, so thread very carefully."

Gary, I know you meant to say "tread very carefully," but threading very carefully is also good advice when getting information from an internet forum. 😉

LOL....how very true. I need to tread more carefully, when posting.

Sounds like you two have a well researched plan that you're comfortable with, Nytngale, so good luck going forward!