Guo Peng, Xing Xiaoming, Wu Keli, Wang Yu, Chen Zhibin, Cao Liang, Li Xiaorong, Li Ning
Department of Urology, Neijiang First People's Hospital, Neijiang, Sichuan, China.
Department of Radiology, Neijiang First People's Hospital, Neijiang, Sichuan, China.
PLoS One. 2025 May 7;20(5):e0323323. doi: 10.1371/journal.pone.0323323. eCollection 2025.
To determine whether 6 months of combined androgen blockade (CAB) treatment would result in metabolic changes of hippocampus and whether metabolic changes correlate with changes in cognition in patients with advanced prostate cancer (PCa).
This is an observational study. Proton magnetic resonance spectroscopy (1H-MRS) was used to observe the changes in the ratios of N-acetylaspartate/creatine (NAA/Cr) and choline-containing compounds/creatine (Cho/Cr) on the bilateral hippocampus for the patients before and 6 months after CAB treatment. Cognitive function was also assessed by the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) at the above two time points. Additionally, a certain number of matched individuals undergoing physical examination were selected as the control group.
CAB group comprised 25 patients with advanced PCa completing follow-up, while control group had 22 healthy controls. Prior to CAB, no significant differences existed in MoCA-BJ scores (including sub-scores) or bilateral hippocampal NAA/Cr and Cho/Cr ratios between groups. Six months after CAB, CAB group exhibited marked declines in MoCA-BJ total score, delayed recall, visuospatial/executive, and attention functions, alongside reduced bilateral hippocampal NAA/Cr and elevated left hippocampal Cho/Cr (P < 0.05).The results of multiple linear regression indicate a positive correlation between NAA/Cr in the left hippocampus and MoCA-BJ total score (β = 4.66, P < 0.001), as well as delayed recall function (β = 2.76, P < 0.001). Mediation analysis confirms that testosterone influences the MoCA-BJ total score and delayed recall function by affecting NAA/Cr in the left hippocampus.
The impact of advanced PCa on cognitive performance could be negligible. However, patients experienced secondary hippocampal injury after CAB, which further led to cognitive dysfunction.
确定6个月的联合雄激素阻断（CAB）治疗是否会导致晚期前列腺癌（PCa）患者海马体的代谢变化，以及代谢变化是否与认知变化相关。
这是一项观察性研究。采用质子磁共振波谱（1H-MRS）观察CAB治疗前及治疗6个月后患者双侧海马体中N-乙酰天门冬氨酸/肌酸（NAA/Cr）和含胆碱化合物/肌酸（Cho/Cr）的比值变化。在上述两个时间点，还通过北京版蒙特利尔认知评估量表（MoCA-BJ）评估认知功能。此外，选取一定数量进行体检的匹配个体作为对照组。
CAB组包括25例完成随访的晚期PCa患者，对照组有22例健康对照。CAB治疗前，两组间MoCA-BJ评分（包括各子评分）或双侧海马体NAA/Cr和Cho/Cr比值无显著差异。CAB治疗6个月后，CAB组MoCA-BJ总分、延迟回忆、视觉空间/执行和注意力功能显著下降，同时双侧海马体NAA/Cr降低，左侧海马体Cho/Cr升高（P<0.05）。多元线性回归结果表明，左侧海马体NAA/Cr与MoCA-BJ总分（β=4.66，P<0.001）以及延迟回忆功能（β=2.76，P<0.001）呈正相关。中介分析证实，睾酮通过影响左侧海马体NAA/Cr来影响MoCA-BJ总分和延迟回忆功能。
晚期PCa对认知表现的影响可能微不足道。然而，患者在CAB治疗后出现继发性海马体损伤，进而导致认知功能障碍。
