Risk of ADT

The Risk Of ADT

According to a new study published in the JAMA Oncology journal, investigators discovered that androgen deprivation therapy in men suffering from prostate cancer is strongly linked to an increased risk of developing dementia. Here we will talk about the risks of ADT.
Androgen deprivation therapy has been in use since 1940s to manage prostate malignancy by reducing the concentration of circulating androgens or key male hormones such as dihydrotestosterone (DHT) and testosterone. It is no surprise that high circulating levels of these key male hormones play a key role in the pathogenesis of prostate malignancy.

What are the current recommendations for using ADT?

Due to the risk of developing certain complications, ADT is not the primary choice of treatment.
According to latest recommendations of American Cancer Society, ADT should be employed when other primary methods of treatment such as radiation and surgery are not an option or in cases where cancer has recurred after an initial treatment procedure via radiation or surgery.
It is also employed in patients who are not ideal candidates for surgery and are relying on radiation therapy, in which case ADT can be used as an adjuvant to radiation therapy to improve the quality of results. So although it is a solution for some men, its important to consider risks of ADT.

Risks of ADT and Complications:

This association is important because according to latest estimates presented by University of Pennsylvania scientist Dr. Kevin T. Nead (who also runs Radiation Oncology department at Perelman School of Medicine) suggested that prescription of ADT in US is more common than one may think. Latest data indicates that each year, more than half million men in the US receive ADT therapy for the management of prostate cancer.
ADT is known to improve survival in men suffering from prostate cancer; however, the cure to cancer comes with certain complications such as decline in cognitive function. In fact, another study that was conducted last year suggested that androgen deprivation therapy is associated with an increased risk of developing Alzheimer’s disease.

Details of the Study:

Based on the results of a new study, history of androgen deprivation therapy for the management of prostate cancer can increase the risk of developing dementia by 2-folds within 5- years of receiving ADT.
The negative effects are known to be mediated by androgen therapy and low serum testosterone levels that aggravates the risk of cardiac disease – which is a recognized risk factor for dementia and other cognitive disorders.
Certain risk factors can further increase the risk of developing dementia in the setting of ADT; such as;

• Risk of developing dementia increases by 13.7% in patients over 70 years of age who received ADT vs. 6% in men who are over 70 years but have not received ADT
• Likewise, men who are under 70 years of age are 2.3% at higher risk of developing cognitive decline with ADT vs. 1% with someone without ADT

It is strongly recommended to speak to your doctor regarding pros and cons of ADT therapy, so you can make an informed decision. The risks of ADT can affect some men more than others.
References:

1. Nead, K. T., Sinha, S., & Nguyen, P. L. (2017). Androgen deprivation therapy in the treatment of prostate cancer and dementia risk: A systematic review and meta-analysis.
2. Owens, S. (2016). Prostate Cancer Treatment Linked to Increased Dementia Risk. Neurology Now.

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