Patients Who Receive Androgen Deprivation Therapy Risk Adverse Cognitive Changes

tion for adverse cognitive effects by a proportion of patients who received androgen-deprivation therapy (ADT). They compared 58 patients with nonlocalized or asymptomatic metastatic prostate cancer (PCa) who were about to commence ADT and observed the participants for 12 months; the findings were compared with those from a cohort of 84 men treated with prostatectomy alone and an additional 88 men who did not have a diagnosis of PCa. They found that participants in the ADT group were more likely to demonstrate impaired cognitive performance than contemporaries in the control/ reference groups over time. Baseline age, cognitive reserve, depressive symptoms, fatigue, and hot flush interference did not moderate the impact of ADT on impaired cognitive performance. In exploratory genetic analyses, GNB3 single nucleotide polymorphism rs1047776 wasassociatedwithincreasedratesofimpairedperformanceovertime in the ADT group. Whether or not ADT induces adverse cognitive changes in a proportionofpatientshasbeendisputedformanyyearsonthebasisof findings from longitudinal studies, including a number that received industry funding. To resolve the question, we undertook a randomized, controlled trial of 82 men with nonlocalized PCa who were allocated to leuprorelin (Lucrin), goserelin (Zoladex), cyproterone acetate(Androcur),ornotreatmentandwhowerereassessedat6and 12monthsafterbaseline;65participantscompleted6months,and62 of these continued for all 12 months of follow-up. 2,3 In addition to a nontreatment PCa control group, a noncancer community reference group was evaluated. Compared with baseline assessments, men who received ADT performedworseontwoof12testsofattentionandmemory;24of50 patients who were randomly assigned to active treatment and who were assessed 6 months later had a clinically significant decline in one ormorecognitivetests,butnotonepatientrandomlyassignedtoclose monitoringorfromthecommunityreferencegroupshowedadecline