Prostate cancer and de­men­tia: Do hor­mone block­ers boost risks?

Kuwait Times - - HEALTH & SCIENCE -

Hor­mone-block­ing drugs for prostate cancer may in­crease men’s chances for de­vel­op­ing de­men­tia, a large study sug­gests, but re­searchers say the re­sults aren’t con­clu­sive enough to rec­om­mend avoid­ing a treat­ment that can im­prove sur­vival.

Cancer pa­tients who used the drugs faced about dou­ble the chances of be­ing di­ag­nosed with de­men­tia over five years, compared with nonusers. The ac­tual risk of de­men­tia, though, was quite low for all the men. The re­searchers an­a­lyzed 20 years of elec­tronic health records for al­most 9,300 prostate cancer pa­tients treated at Stan­ford Univer­sity’s health sys­tem. About 20 per­cent of the men were given hor­mone block­ers, which lower lev­els of testos­terone and other hor­mones that can fuel cancer growth.

After five years of fol­low-up, about 8 per­cent of men on hor­mone block­ers were di­ag­nosed with de­men­tia ver­sus al­most 4 per­cent of nonusers. The re­sults were pub­lished Thurs­day in the jour­nal JAMA On­col­ogy . The re­searchers and oth­ers say rig­or­ous stud­ies are needed to prove whether the widely used treat­ment is risky.

Half re­ceive treat­ment

About half of all prostate cancer pa­tients in de­vel­oped coun­tries re­ceive the treat­ment, in­clud­ing about 500,000 US men cur­rently on the drugs. How the medicines might in­crease de­men­tia risks is un­cer­tain. One pos­si­ble ex­pla­na­tion is their ef­fect on testos­terone lev­els. That hor­mone can drive cancer cell growth, but low lev­els have also been linked with heart and blood ves­sel prob­lems that can also con­trib­ute to de­men­tia.

The treat­ment is of­ten used for men who don’t re­ceive surgery or ra­di­a­tion or whose cancer has spread to other parts of the body. It’s typ­i­cally given in pills and in­jec­tions for a few months up to a few years although some men with ad­vanced dis­ease stay on the treat­ment in­def­i­nitely, said Dr. Kevin Nead, the lead au­thor and a cancer doc­tor at the Univer­sity of Penn­syl­va­nia.

Some men who can’t tol­er­ate the harsh treat­ment be­cause of older age or other health prob­lems are some­times put on hor­mone block­ers. Nead said the re­searchers took into ac­count other ail­ments that may also in­crease risks for de­men­tia. But he said some con­di­tions may have been missed and he stressed that more re­search is needed. Some but not all pre­vi­ous stud­ies that also re­viewed med­i­cal records have also sug­gested the treat­ment may in­crease risks for de­men­tia. Men in the cur­rent study were part of a larger study that in­cluded Univer­sity of Penn­syl­va­nia pa­tients and that found an in­creased risk for Alzheimer’s dis­ease, one type of de­men­tia. That study, co-au­thored by Nead, was pub­lished last De­cem­ber in the Jour­nal of Clin­i­cal On­col­ogy.

Such stud­ies typ­i­cally use di­ag­no­sis and billing codes in med­i­cal records to gauge treat­ment risks or dis­ease trends. Nead and col­leagues used a newer com­put­er­ized method that scans elec­tronic records in­clud­ing doc­tors’ and nurses’ writ­ten notes, to find the same kind of in­for­ma­tion.

A JAMA On­col­ogy ed­i­to­rial by Van­der­bilt Univer­sity physi­cians says the re­sults sug­gest a link, not a cause. “The au­thors rightly frame their con­clu­sions as as­so­ci­a­tions in need of fur­ther study,” Drs. Colin Walsh and Kevin John­son said in the ed­i­to­rial.

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