Editor’s Note
Peter Kafka’s commentary refers to a study published last week in the JAMA Network Open; you can find it here. The topic is not new – there have been several previous studies. This Medscape article from 2016 summarizes and references several prior research articles. Note you will need to sign up to Medscape to access; it is free and worthwhile. And there are several pertinent studies amongst the references to the JAMA Network Open article if you care to chase them down.
It is very important to note that all the studies identifying this link between ADT and dementia are epidemiological based on populations of various sizes and definitions. This study only considers men over 66 between 1996-2003 followed through 2013 taken from the SEER-Medicare data base. With any epidemiological study, observations are correlative NOT causative.
Btw, it is TOTALLY fortuitous this post follows the previous one on commonly prescribed drugs and dementia; we had no advance notice that the ADT & Dementia study would be published July 5!
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If I had to chose a title for where my thoughts have been the last couple of days it would be;
Many of you know that I have resided in Maui, Hawaii for the past 30 years. Hawaii has some odd customs. I think that the second most popular liquid consumed here after BEER might be Roundup (joke). When I moved here, I sensed that this herbicide was not a wise choice and I decided that rather than try to beat back the jungle with chemicals, it was best to not use them and get used to my property looking a bit ragged all the time. Now with recent studies and lawsuits around the country involving this product I remain more convinced than ever that I made the right choice.
The reason that I mention the story above is that I have been receiving a number of articles that seem to be based upon studies linking the use of ADT for prostate cancer to increased risk of dementia in older men. This is not new information to many of us. And to date I don’t believe that there has been a definitive link, but there is plenty of data and research is being done on this link. Because men in the US are living longer, and various treatments particularly for more advanced prostate cancer are extending the lives of many men, it makes it difficult to draw absolute conclusions because of these and other factors.
For men in the Low and Intermediate risk category of prostate cancer this topic might not be something to even be concerned about. For those men most ADT courses if suggested at all are only 6 months or so. But for men like myself with more advanced disease and dependent upon ADT for longer periods to arrest my disease, it is a subject worth visiting. ADT in some form or another has been a standard of care for prostate cancer for quite a few years now. If it turns out that there is a link to increased risk of mental deterioration from the use of ADT how does one weigh the risk and assimilate the information? If given the choice of increased risk of dementia or increased risk of death from prostate cancer, how would you decide?
I have no answers to this dilemma. At this time very few doctors raise the concern to their patients. And some physicians feel that it should not be broached at all. And I hesitated to even bring it up in this forum. However, more studies are coming out utilizing the extensive data available over the past 30 years and it might give many of us pause to reflect.