One of the most worrisome concerns about the side effects of ADT relates to potential cognitive effects. It is understandably scary for patients and those who live with them to hear that androgen deprivation might affect patients’ ability to remember and think.
In this new comprehensive review, the authors examined 31 previous studies and note that half of them failed to find evidence that ADT negatively affects cognitive functioning. However, they also found 11 reports documenting negative effects on cognitive function and that was enough for them to conclude that the concern is real and warrants more research. The primary cognitive effects they found were on memory, most frequently followed by effects on spatial processing ability.
The authors reached two conclusions. The first one is really not new and has been in the literature for close to 20 years. It is that, when patients are discussing with their clinicians whether to start ADT, the “clinician should discuss…potential [cognitive] side effect[s]”.
The researchers’ second major point was about future research. They argue that future studies should be randomized and use: 1) “a neuropsychological test battery” along with 2) “innovative techniques to examine brain function, structure and metabolism”. The concern about test batteries comes from the challenges they had in making sense of all the data because previous researchers have used a wildly diverse set of cognitive tests, making it difficult to extract consistent findings.
The reference to "innovative techniques" is built upon the fact that there are now a variety of ways, such as using PET and MRI scanners, to visualize changes in the brain that can then be correlated with changes in cognitive function. The authors review the few studies that have been done that way. Their call for more research along those lines is, we believe, well justified. Future studies can go beyond just showing that ADT affects men's brains. We know that already. Using, however, the newer imaging techniques will help us understand how, when, and where ADT influences cognitive function. Combining rigorous cognitive testing with modern imaging will help us know exactly how androgen deprivation affects the brain and can document interventions that are most effective in limiting the negative cognitive effects of ADT.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/34128263/
Reference:
Andela CD, Matte R, Jazet IM, Zonneveld WC, Schoones JW, Meinders AE. Effect of androgen deprivation therapy on cognitive functioning in men with prostate cancer: A systematic review. Int J Urol. 2021 Aug;28(8):786-798. doi: 10.1111/iju.14596. Epub 2021 Jun 14. PMID: 34128263.