Department of Internal Medicine & Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT 06519, USA.
BMC Cancer. 2012 Aug 27;12:371. doi: 10.1186/1471-2407-12-371.
Despite a lack of consensus regarding effectiveness, androgen deprivation therapy (ADT) is a common treatment for non-metastatic, low-risk prostate cancer. To examine a particular clinical concern regarding the possible impact of ADT on cognition, the current study combined neuropsychological testing with functional magnetic resonance imaging (fMRI) to assess both brain activation during cognitive performance as well as the integrity of brain connectivity.
In a prospective observational cohort analysis of men with non-metastatic prostate cancer at a Veterans Affairs medical center, patients receiving ADT were compared with patients not receiving ADT at baseline and at 6 months. Assessments included fMRI, the N-back task (for working memory), the stop-signal task (for cognitive control), and a quality of life questionnaire.
Among 36 patients enrolled (18 in each group), 30 completed study evaluations (15 in each group); 5 withdrew participation and 1 died. Results for the N-back task, stop-signal task, and quality of life were similar at 6 months vs. baseline in each group. In contrast, statistically significant associations were found between ADT use (vs. non use) and decreased medial prefrontal cortical activation during cognitive control, as well as decreased connectivity between the medial prefrontal cortex and other regions involved with cognitive control.
Although ADT for 6 months did not affect selected tests of cognitive function, brain activations during cognitive control and functional brain connectivity were impaired on fMRI. The long-term clinical implications of these changes are not known and warrant future study.
尽管关于有效性缺乏共识，但雄激素剥夺疗法（ADT）是治疗非转移性低危前列腺癌的常用方法。为了研究 ADT 对认知可能产生影响的一个特定临床问题，本研究将神经心理学测试与功能磁共振成像（fMRI）相结合，以评估认知表现期间的大脑激活以及大脑连接的完整性。
在退伍军人事务医疗中心对患有非转移性前列腺癌的男性进行前瞻性观察队列分析中，在基线和 6 个月时，比较接受 ADT 的患者与未接受 ADT 的患者。评估包括 fMRI、N-back 任务（用于工作记忆）、停止信号任务（用于认知控制）和生活质量问卷。
在纳入的 36 名患者（每组 18 名）中，有 30 名完成了研究评估（每组 15 名）；5 名退出参与，1 名死亡。在每组中，N-back 任务、停止信号任务和生活质量的结果在 6 个月时与基线相似。相比之下，在接受 ADT（与未接受 ADT 相比）与认知控制期间内侧前额叶皮质激活减少以及内侧前额叶皮质与其他认知控制相关区域之间的连接减少之间发现了统计学上显著的关联。
尽管接受 ADT 治疗 6 个月并未影响认知功能的特定测试，但 fMRI 显示认知控制期间的大脑激活和功能大脑连接受损。这些变化的长期临床意义尚不清楚，需要进一步研究。
