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Supportive Care in Cancer

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01-01-2010 | Original Article

Cognitive impairment in men treated with luteinizing hormone–releasing hormone agonists for prostate cancer: a controlled comparison

Authors: Heather S. L. Jim, Brent J. Small, Stephen Patterson, Raoul Salup, Paul B. Jacobsen

Published in: Supportive Care in Cancer | Issue 1/2010

Abstract

Goals of work

Data suggest that treatment with luteinizing hormone–releasing hormone (LHRH) agonists may be associated with reduced cognitive functioning. The purpose of the current study was to compare rates of clinically significant cognitive impairment in men treated with LHRH agonists to a matched sample of healthy men without cancer.

Materials and methods

Participants were 48 men receiving LHRH agonist therapy for prostate cancer and 48 men with no history of cancer matched to patients on age and education. Participants were administered a battery of neuropsychological tests assessing the domains of verbal memory, verbal fluency, visuospatial memory, visuospatial abilities, and executive function. Clinically significant impairment on individual tests was defined as −1.5 SD below the normative mean; overall impairment was defined as impaired performance on two or more tests.

Main results

Patients did not differ from comparison subjects in age, ethnicity, race, education, or annual household income (p's > 0.05). No statistically significant differences in test means were found. Nevertheless, patients displayed greater overall impairment in cognitive functioning than comparison subjects (42% of patients versus 19% of comparison subjects, p < 0.05). Among patients, prior prostatectomy was associated with impaired immediate and delayed verbal memory (p's < 0.05).

Conclusions

Current findings suggest that LHRH agonists and surgery for prostate cancer are associated with clinically significant impairment in cognitive functioning. Longitudinal studies are needed to examine changes in cognitive impairment before and after surgical and hormonal treatment for prostate cancer. Patients undergoing LHRH agonist therapy should be monitored for cognitive changes while on treatment.

Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E, Mendelson DS, Middleton R, Sharp SA, Smith TJ, Talcott J, Taplin M, Vogelzang NJ, Wade JL 3rd, Bennett CL, Scher HI (2007) Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 25:1596–1605. doi:10.1200/JCO.2006.10.1949 CrossRefPubMed

Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, Mattelaer J, Lopez Torecilla J, Pfeffer JR, Lino Cutajar C, Zurlo A, Pierart M (2002) Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 360:103–106. doi:10.1016/S0140-6736(02)09408-4 CrossRefPubMed

Bolla M, de Reijke TM, Zurlo A, Collette L (2002) Adjuvant hormone therapy in locally advanced and localized prostate cancer: three EORTC trials. Front Radiat Ther Oncol 36:81–86. doi:10.1159/000061332 CrossRefPubMed

Group The Medical Research Council Prostate Cancer Working Party Investigators (1997) Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial. The Medical Research Council Prostate Cancer Working Party Investigators Group. Br J Urol 79:235–246

Barrass BJ, Thurairaja R, Persad RA (2004) More should be done to prevent the harmful effects of long-term androgen ablation therapy in prostate cancer. BJU Int 93:1175–1176. doi:10.1111/j.1464-410X.2004.04888.x CrossRefPubMed

Nelson CJ, Lee JS, Gamboa MC, Roth AJ (2008) Cognitive effects of hormone therapy in men with prostate cancer: a review. Cancer 113:1097–1106. doi:10.1002/cncr.23658 CrossRefPubMed

Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358:1250–1261. doi:10.1056/NEJMoa074311 CrossRefPubMed

Ulloa EW, Salup R, Patterson SG, Jacobsen PB (2009) Relationship between hot flashes and distress in men receiving androgen deprivation therapy for prostate cancer. J Consult Clin Psychol (in press).

Keating NL, O'Malley AJ, Smith MR (2006) Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 24:4448–4456. doi:10.1200/JCO.2006.06.2497 CrossRefPubMed

10.

Salminen E, Portin R, Korpela J, Backman H, Parvinen LM, Helenius H, Nurmi M (2003) Androgen deprivation and cognition in prostate cancer. Br J Cancer 89:971–976. doi:10.1038/sj.bjc.6601235 CrossRefPubMed

11.

Green HJ, Pakenham KI, Headley BC, Yaxley J, Nicol DL, Mactaggart PN, Swanson C, Watson RB, Gardiner RA (2002) Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial. BJU Int 90:427–432. doi:10.1046/j.1464-410X.2002.02917.x CrossRefPubMed

12.

Green HJ, Pakenham KI, Headley BC, Yaxley J, Nicol DL, Mactaggart PN, Swanson CE, Watson RB, Gardiner RA (2004) Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: a randomized controlled trial. BJU Int 93:975–979. doi:10.1111/j.1464-410X.2004.04763.x CrossRefPubMed

13.

Jenkins VA, Bloomfield DJ, Shilling VM, Edginton TL (2005) Does neoadjuvant hormone therapy for early prostate cancer affect cognition? Results from a pilot study. BJU Int 96:48–53. doi:10.1111/j.1464-410X.2005.05565.x CrossRefPubMed

14.

Bussiere JR, Beer TM, Neiss MB, Janowsky JS (2005) Androgen deprivation impairs memory in older men. Behav Neurosci 119:1429–1437. doi:10.1037/0735-7044.119.6.1429 CrossRefPubMed

15.

Cherrier MM, Aubin S, Higano CS (2008) Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non-metastatic prostate cancer. Psychooncology 18:237–247

16.

Salminen EK, Portin RI, Koskinen AI, Helenius HY, Nurmi MJ (2005) Estradiol and cognition during androgen deprivation in men with prostate carcinoma. Cancer 103:1381–1387. doi:10.1002/cncr.20962 CrossRefPubMed

17.

Almeida OP, Waterreus A, Spry N, Flicker L, Martins RN (2004) One year follow-up study of the association between chemical castration, sex hormones, beta-amyloid, memory and depression in men. Psychoneuroendocrinology 29:1071–1081. doi:10.1016/j.psyneuen.2003.11.002 CrossRefPubMed

18.

Salminen EK, Portin RI, Koskinen A, Helenius H, Nurmi M (2004) Associations between serum testosterone fall and cognitive function in prostate cancer patients. Clin Cancer Res 10:7575–7582. doi:10.1158/1078-0432.CCR-04-0750 CrossRefPubMed

19.

Joly F, Alibhai SM, Galica J, Park A, Yi QL, Wagner L, Tannock IF (2006) Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. J Urol 176:2443–2447. doi:10.1016/j.juro.2006.07.151 CrossRefPubMed

20.

Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441PubMed

21.

Benedict R, Schretlen D, Groninger L, Brandt J (1998) Hopkins Verbal Learning Test Revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol 12:43–55. doi:10.1076/clin.12.1.43.1726

22.

Brandt J (1991) The Hopkins Verbal Learning Test: development of a new memory test with six equivalent forms. Clin Neuropsychol 5:125–142. doi:10.1080/13854049108403297 CrossRef

23.

Benton A, Hamsher K (1989) Multilingual aphasia examination. AJA, Iowa City, IA

24.

Benedict R (1997) Brief visuo-spatial memory test-revised (BVMT-R). Psychological Assessment Resources, Odessa, FL

25.

Ekstrom RB, French JW, Hartman HH (1976) Manual for kit of factor-referenced cognitive tests. Educational Testing Service, Princeton, N.J

26.

Smith A (1982) Symbol digit modalities test (SDMT) manual (Revised). Western Psychological Services, Los Angeles, CA

27.

Brandt J, Benedict RHB (2001) Hopkins verbal learning test revised. Psychological Assessment Resources, Lutz, FL

28.

Benedict RHB (1997) Brief Visuospatial memory test revised. Psychological Assessment Resources, Lutz, FL

29.

Spreen O, Strauss E (1998) A Compendium of neuropsychological tests: administration, norms, and commentary, 2nd edn. Oxford University Press, New York

30.

Wefel JS, Lenzi R, Theriault RL, Davis RN, Meyers CA (2004) The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma. Cancer 100:2292–2299. doi:10.1002/cncr.20272 CrossRefPubMed

31.

Chinn S (2000) A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med 19:3127–3131. doi:10.1002/1097-0258(20001130)19:22<3127::AID-SIM784>3.0.CO;2-M CrossRefPubMed

32.

Cohen J (1988) Statistical power analysis for the behaivoral sciences, 2nd edn. Erlbaum, Hillsdale, NJ

33.

Lunenfeld B (2003) Androgen therapy in the aging male. World J Urol 21:292–305. doi:10.1007/s00345-003-0366-8 CrossRefPubMed

34.

Cherrier MM, Asthana S, Plymate S, Baker L, Matsumoto AM, Peskind E, Raskind MA, Brodkin K, Bremner W, Petrova A, LaTendresse S, Craft S (2001) Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology 57:80–88. doi:10.1159/000047227 PubMed

35.

Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM, Resnick SM (2002) Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab 87:5001–5007. doi:10.1210/jc.2002-020419 CrossRefPubMed

Title: Cognitive impairment in men treated with luteinizing hormone–releasing hormone agonists for prostate cancer: a controlled comparison
Authors: Heather S. L. Jim
Brent J. Small
Stephen Patterson
Raoul Salup
Paul B. Jacobsen
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 1/2010
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-009-0625-3

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