Cancer Res Treat.  2019 Apr;51(2):593-602. 10.4143/crt.2018.119.

Correlation of Androgen Deprivation Therapy with Cognitive Dysfunction in Patients with Prostate Cancer: A Nationwide Population-Based Study Using the National Health Insurance Service Database

• Tae BS
• Jeon BJ
• Shin SH
• Choi H
• Bae JH
• Park JY

• KMID: 2464406
• DOI: http://doi.org/10.4143/crt.2018.119

Abstract

PURPOSE
The purpose of this study was to evaluate the association of androgen deprivation therapy (ADT) with cognitive dysfunction.
MATERIALS AND METHODS
Using the National Health Insurance Service database of the entire Korean adult prostate cancer population (n=236,391), data on ADT and cognitive dysfunction between 2008 and 2015 were analyzed. We excluded patients previously diagnosed with cognitive dysfunction, dementia, or a cerebral event history. We tested the effect of ADT on the risk of cognitive dysfunction using propensity score-matched Cox proportional hazards regression models and Kaplan-Meier survival analysis. Our final cohort comprised of 35,401 individuals with prostate cancer, including 24,567 men (70.6%) who underwent ADT.
RESULTS
During a mean follow-up period of 4.1 years, 4,741 patients were newly diagnosed with cognitive dysfunction. A statistically significant association was found between ADT and the risk of cognitive dysfunction (hazard ratio, 1.169; p=0.002). Meanwhile, age (≥ 70 years), diabetes, hypertension, cardiovascular history, and peripheral vascular disease were identified as factors that contribute to the increased risk of cognitive dysfunction. In contrast, the use of statins and aspirin was associated with a lower risk of cognitive dysfunction. Kaplan-Meier analysis demonstrated that patients aged 70 years or older who underwent ADT had the lowest cumulative probability of remaining cognitive dysfunction-free (log-rank p < 0.001).
CONCLUSION
Our results revealed an association between the use of ADT for the treatment of prostate cancer and an increased risk of cognitive dysfunction in a nationwide population-based study. This finding should be further evaluated in prospective studies.

Keyword

Prostate neoplasm; Androgen deprivation therapy; Cognitive dysfunction; Nationwide population-based study

MeSH Terms

Adult
Aspirin
Cohort Studies
Dementia
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypertension
Kaplan-Meier Estimate
Male
National Health Programs*
Peripheral Vascular Diseases
Prospective Studies
Prostate*
Prostatic Neoplasms*
Aspirin

Figure

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  Fig. 1. Study flow diagram of the cohort of patients newly diagnosed with prostate cancer in the Korean national health insurance system between 2008 and 2015. ADT, androgen deprivation therapy.

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  Fig. 2. Kaplan-Meier curves of cognitive dysfunction-free probability in the unmatched cohort. (A) Kaplan-Meier curves of cognitive dysfunction-free probability in patients with prostate cancer who did undergo androgen deprivation therapy (ADT) (red) and did not undergo ADT (blue). (B) Kaplan-Meier curves of cognitive dysfunction-free probability in patients with prostate cancer aged less than 70 years who did not undergo ADT (blue), those aged less than 70 years who did undergo ADT (red), those aged 70 years or older who did not undergo ADT (green), and those aged less than 70 years who did undergo ADT (orange).

• 

  Fig. 3. Kaplan-Meier curves of cognitive dysfunction-free probability in the propensity score-matched cohort. (A) KaplanMeier curves of cognitive dysfunction-free probability in patients with prostate cancer with androgen deprivation therapy (ADT) (red) and without ADT (blue). (B) Kaplan-Meier curves of cognitive dysfunction-free probability in patients with prostate cancer aged less than 70 years who did not undergo ADT (blue), those aged less than 70 years who did undergo ADT (red), those aged 70 years or older who did not undergo ADT (green), and those aged less than 70 years who did undergo ADT (orange).

Reference

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