Androgen Deprivation Therapy and Cognitive Function in Prostate Cancer

Abstract

Purpose of review: Androgen deprivation therapy (ADT) is widely used in prostate cancer. Interest in assessing how ADT impacts cognition is growing.

Recent findings: Studies in animals and humans suggest that androgens may affect cognitive function. However, extant studies utilizing common neurocognitive tests have not consistently demonstrated ADT-induced cognitive impairment. Retrospective analyses investigating the association between ADT and risk of dementia in large electronic patient databases have also produced conflicting results. There is only limited data on ADT-induced changes in the brain as detected by functional imaging. It remains unclear whether cognitive deficits can occur in a patient undergoing ADT. Commonly used neurocognitive tests may not be optimal for detection of more subtle but clinically relevant cognitive impairment. While large electronic patient databases are attractive sources of information, their heterogeneity, complexity, and potential reporting biases can be a challenge. Better tools are needed to assess the cognitive impact of ADT prospectively.

Keywords: Alzheimer’s; Androgen; Androgen deprivation therapy; Antiandrogen; Cognitive function; Dementia; Functional MRI; Functional brain imaging; Neuropsychological testing; PET; Population-based cohort.