Department of Urology, Ryhov Hospital, Jönköping, Sweden.
Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.
BJU Int. 2019 Jul;124(1):87-92. doi: 10.1111/bju.14666. Epub 2019 Feb 6.
To study whether androgen deprivation therapy (ADT), the mainstay treatment for advanced and disseminated prostate cancer, is associated with risk of dementia.
Risk of dementia in men with prostate cancer primarily managed with ADT or watchful waiting (WW) in the Prostate Cancer Database Sweden, PCBaSe, was compared with that in prostate cancer-free men, matched on birth year and county of residency. We used Cox regression to calculate the hazard ratios (HRs) for Alzheimer's and non-Alzheimer's dementia (vascular dementia, dementia secondary to other diseases or unspecified dementias) for different types and duration of ADT and oral antiandrogens (AAs) as well as for men managed with WW.
A total of 25 967 men with prostate cancer and 121 018 prostate cancer-free men were followed for a median of 4 years. In both groups 6% of the men were diagnosed with dementia. In men with prostate cancer, gonadotropin-releasing hormone agonist treatment ( HR 1.15, 95% confidence interval [CI] 1.07-1.23) and orchiectomy (HR 1.60, 95% CI 1.32-1.93) were associated with an increased risk of dementia, as compared to no treatment in prostate cancer-free men; however, this increase in risk was only observed for non-Alzheimer's dementia and occurred from year 1-4 after start of ADT. No increase in risk for any type of dementia was observed for men treated with AAs or for men on WW.
This population-based cohort study does not support previous observations of an increased risk of Alzheimer's dementia for men on ADT; however, there was a small increase in risk of non-Alzheimer's dementia.
研究雄激素剥夺疗法（ADT）作为治疗晚期和转移性前列腺癌的主要方法是否与痴呆风险相关。
在瑞典前列腺癌数据库（PCBaSe）中，比较了主要接受 ADT 或观察等待（WW）治疗的前列腺癌患者与前列腺癌患者的痴呆风险，匹配了出生年份和居住县。我们使用 Cox 回归计算了不同类型和持续时间的 ADT 和口服抗雄激素（AA）以及接受 WW 治疗的男性患阿尔茨海默病和非阿尔茨海默病痴呆（血管性痴呆、其他疾病引起的痴呆或未特指的痴呆）的风险比（HR）。
共有 25967 名患有前列腺癌的男性和 121018 名无前列腺癌的男性接受了中位 4 年的随访。两组中均有 6%的男性被诊断为痴呆。与无前列腺癌的男性相比，前列腺癌患者接受促性腺激素释放激素激动剂治疗（HR 1.15，95%置信区间 [CI] 1.07-1.23）和睾丸切除术（HR 1.60，95% CI 1.32-1.93）与痴呆风险增加相关；然而，这种风险增加仅在非阿尔茨海默病痴呆中观察到，且发生在 ADT 开始后的第 1-4 年。未观察到 AA 治疗或 WW 治疗的男性任何类型痴呆的风险增加。
这项基于人群的队列研究不支持之前关于 ADT 治疗男性阿尔茨海默病风险增加的观察结果；然而，确实存在非阿尔茨海默病痴呆风险的小幅增加。
