ADT tied to dementia risk in elderly men with prostate cancer

  • JAMA Netw Open
  • 3 Jul 2019

  • International Clinical Digest
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Takeaway

  • Androgen deprivation therapy (ADT) is tied to an elevated 10-year risk for Alzheimer disease (AD) or dementia among elderly men with prostate cancer.

Why this matters

  • Findings warrant careful evaluation of ADT risks and benefits in patients with prolonged life expectancy; dementia risk factors should also be considered.

Study design

  • 154,089 men age ≥66 years from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, diagnosed with prostate cancer, 1996-2003, followed to 2013.
  • 40.5% received ADT within 2 years (mean age, 76.0±6.0 vs no-ADT, 74.3±6.0 years; P<.001>
  • Mean follow-up, 8.3±4.7 years.
  • Funding: Agency for Healthcare and Research Quality.

Key results

  • ADT exposure (vs no ADT) was tied to increased rates of AD (13.1% vs 9.4%) and dementia (21.6% vs 15.8%) diagnoses.
  • Propensity-matched analysis linked ADT to:
    • 14% increased risk for AD: 1.14 (95% CI, 1.10-1.18).
    • 20% increased risk for dementia: 1.20 (1.17-1.24).
  • Respective risks for AD and dementia by ADT dose (HRs; 95% CIs):
    • 1-4 doses: 1.19 (1.15-1.24) and 1.19 (1.15-1.23).
    • 5-8 doses: 1.28 (1.22-1.35) and 1.24 (1.19-1.29).
    • >8 doses: 1.24 (1.16-1.34) and 1.21 (1.15-1.28).
  • Number needed to harm:
    • AD: 18 (95% CI, 17-19).
    • Dementia: 10 (9.5-11).

Limitations

  • Retrospective design.
  • Potentially nongeneralizable.

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