Ihrig Andreas, Pernt Pascal Marino, Zschäbitz Stefanie, Huber Johannes, Friederich Hans-Christoph, Bugaj Till J, Maatouk Imad
Division of Psycho-Oncology, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.
Department of Medical Oncology, National Centre for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
Int Urol Nephrol. 2023 Nov;55(11):2733-2739. doi: 10.1007/s11255-023-03712-z. Epub 2023 Jul 19.
Although the growing treatment landscape for metastatic prostate cancer (mPC) has revealed new opportunities, it has also provided challenges, such as undesirable side effects. The aim of the present study was to provide further data on domain-specific cognitive impairments in mPC patients with androgen deprivation therapy (ADT) and new hormonal agents.
Fifty-eight patients (71 ± 8 years) with mPC were investigated using a cross-sectional design. All patients had received some form of ADT (93% had received luteinizing hormone-releasing hormone (LHRH) analogs/antagonists), 66% had received chemotherapy, and 84% had received anti-resorptive therapy. We evaluated learning and memory, processing speed, and executive functions, as recommended by the International Cognition and Cancer Task Force, to determine neurocognitive deficits.
Patients treated with ADT scored significantly lower on all neurocognitive tests and showed significantly more neurocognitive deficits (38-62%) than age-adjusted reference samples (16%, p < 0.05). Cognitive deficits were mild in most cases and predominantly affected visuomotor processing speed (48%). Moderate and severe deficits were found in 11% and 5% of patients, respectively, with word fluency as the predominant deficit (23%). No associations were found between the type or duration of treatment and the severity of cognitive deficits.
Treatment of mPC with ADT is correlated with neurocognitive deficits in several cognitive domains. Language skills and processing speed were most frequently impaired. However, a consistent pattern of cognitive impairment was not identified. Neurocognitive deficits should be considered in phase III and IV trials.
The study was registered in the German Clinical Trials Registry (DRKS00017727).
尽管转移性前列腺癌（mPC）不断发展的治疗前景带来了新机遇，但也带来了挑战，比如不良副作用。本研究的目的是提供更多关于接受雄激素剥夺疗法（ADT）和新型激素药物治疗的mPC患者特定领域认知障碍的数据。
采用横断面设计对58例mPC患者（71±8岁）进行研究。所有患者均接受了某种形式的ADT（93%接受了促性腺激素释放激素（LHRH）类似物/拮抗剂），66%接受了化疗，84%接受了抗吸收治疗。我们按照国际认知与癌症特别工作组的建议，评估学习与记忆、处理速度和执行功能，以确定神经认知缺陷。
接受ADT治疗的患者在所有神经认知测试中的得分显著更低，且与年龄调整后的参考样本相比，显示出显著更多的神经认知缺陷（38 - 62%）（参考样本为16%，p < 0.05）。在大多数情况下，认知缺陷为轻度，主要影响视觉运动处理速度（48%）。分别有11%和5%的患者存在中度和重度缺陷，以词汇流畅性为主要缺陷（23%）。未发现治疗类型或持续时间与认知缺陷严重程度之间存在关联。
mPC患者接受ADT治疗与多个认知领域的神经认知缺陷相关。语言技能和处理速度最常受损。然而，未发现一致的认知障碍模式。在III期和IV期试验中应考虑神经认知缺陷。
该研究已在德国临床试验注册中心（DRKS00017727）注册。
