Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA.
Clin Transl Oncol. 2022 May;24(5):733-741. doi: 10.1007/s12094-021-02727-1. Epub 2021 Nov 7.
Prostate cancer is the second most common form of cancer in men. For advanced, high risk prostate cancer, androgen deprivation therapy (ADT) is the preferred treatment and can induce remission, but resistance to ADT brings biochemical recurrence and progression of cancer. ADT brings adverse effects such as erectile dysfunction, decreased libido, and diminished physical strength. It is estimated that between 25 and 50% of men on ADT manifest some form of cognitive dysfunction that may be self-reported or reported by a family member. There is concern that impaired cognitive function with ADT is due to loss of testosterone support. Testosterone and its metabolites are known to possess neuroprotective properties. While a direct causal relationship between ADT and cognitive decline in prostate cancer patients has not been established, this review describes the controversy surrounding the possible connection between ADT and neurocognitive deterioration. The cellular and molecular mechanisms believed to underlie the protection of neuronal integrity by androgens are discussed. Results from animal models and human clinical studies are presented. Finally, we call attention to lifestyle modifications that may minimize cognitive issues in prostate cancer patients.
前列腺癌是男性中第二常见的癌症。对于晚期高危前列腺癌，雄激素剥夺疗法（ADT）是首选治疗方法，可以诱导缓解，但对 ADT 的耐药性会导致生化复发和癌症进展。ADT 带来不良反应，如勃起功能障碍、性欲降低和体力下降。据估计，接受 ADT 的男性中有 25%至 50%表现出某种形式的认知功能障碍，这些障碍可能是自我报告的，也可能是家庭成员报告的。有人担心 ADT 导致的认知功能障碍是由于缺乏睾酮支持。已知睾酮及其代谢物具有神经保护特性。虽然 ADT 与前列腺癌患者认知能力下降之间的直接因果关系尚未建立，但本综述描述了围绕 ADT 与神经认知恶化之间可能存在联系的争议。讨论了雄激素维持神经元完整性的细胞和分子机制。介绍了来自动物模型和人类临床研究的结果。最后，我们呼吁注意生活方式的改变，这些改变可能会最大限度地减少前列腺癌患者的认知问题。
