University Health Network, Toronto, Ontario, Canada.
J Clin Oncol. 2010 Dec 1;28(34):5030-7. doi: 10.1200/JCO.2010.30.8742. Epub 2010 Nov 1.
To evaluate the effects of androgen-deprivation therapy (ADT) on cognitive function in men with nonmetastatic prostate cancer (PC).
The following three groups of men age 50 years or older and matched on age and education were enrolled: patients with PC starting continuous ADT (n = 77), patients with PC not receiving ADT (PC controls, n = 82), and healthy controls (n = 82). A battery of 14 neuropsychological tests, examining eight cognitive domains, was administered at baseline, 6 months, and 12 months. Changes in cognitive scores over time were analyzed using the following three approaches: multivariable linear regression; the proportion of participants per group with 1 standard deviation (SD) or greater declines, and the proportion of participants who declined by at least 1.5 SD on two or more tests.
The mean age and education level of participants were 68.9 years (range, 50 to 87 years) and 15.4 years of education (range, 8 to 24 years), respectively. Adjusted for age and education, all three cohorts had similar cognitive scores at baseline other than in one test of working memory. In adjusted regressions, ADT use was not associated with significant changes in the domains of attention/processing speed, verbal fluency, verbal memory, visual memory, or cognitive flexibility at either 6 months (all P > .05) or 12 months (all P > .05). One test each of immediate memory (P = .029), working memory (P = .031), and visuospatial ability (P = .034) were worse among ADT users than controls at 12 months, but these findings were not confirmed using other analytic approaches.
There is no consistent evidence that 12 months of ADT use has an adverse effect on cognitive function in elderly men with PC.
评估去势治疗（ADT）对非转移性前列腺癌（PC）男性认知功能的影响。
招募了三组年龄在 50 岁或以上且年龄和教育程度相匹配的男性：开始接受连续 ADT 的 PC 患者（n = 77）、未接受 ADT 的 PC 对照组患者（n = 82）和健康对照组患者（n = 82）。在基线、6 个月和 12 个月时，使用 14 项神经心理学测试套件，评估 8 个认知领域，检测认知分数的变化。采用以下三种方法分析随时间的认知评分变化：多变量线性回归；每个组中认知分数下降 1 个标准差（SD）或以上的参与者比例，以及在两个或更多测试中下降至少 1.5 SD 的参与者比例。
参与者的平均年龄和教育水平分别为 68.9 岁（范围为 50 至 87 岁）和 15.4 年教育程度（范围为 8 至 24 年）。在调整年龄和教育程度后，除了一项工作记忆测试外，三组的认知评分在基线时均相似。在调整后的回归分析中，在 6 个月（所有 P >.05）或 12 个月（所有 P >.05）时，ADT 使用与注意力/处理速度、言语流畅性、言语记忆、视觉记忆或认知灵活性等领域的显著变化无关。在 12 个月时，ADT 使用者在即时记忆（P =.029）、工作记忆（P =.031）和视空间能力（P =.034）等方面的测试结果均差于对照组，但这些发现并未通过其他分析方法得到证实。
在老年 PC 男性中，12 个月的 ADT 使用没有一致的证据表明会对认知功能产生不利影响。
