Androgen deprivation therapy (ADT) has been the standard of care for management of metastatic prostate cancer for more than 70 years. Its use in locally advanced disease is defined by prospective evidence in a number of clinical settings. However, during the past 25 years, the greatest growth in use has been in the prostate-specific antigen (PSA)-only disease state, for which prospective evidence is lacking. Whereas the metabolic and bone issues related to ADT are well described, the impact on neurocognitive function remains poorly defined.
Using a novel, text-processing pipeline method to interrogate data from electronic medical records, investigators analyzed data from two large academic medical centers to explore a potential association between ADT and the development of Alzheimer disease (AD). During a 19-year period, data from approximately 40 million patient encounters led to identification of 16,888 men with prostate cancer who met the study criteria, which excluded men subsequently treated with chemotherapy or who had a history of dementia or stroke. Of this group, 14% received ADT with a median time from prostate cancer diagnosis to therapy of 36 days.
During a median follow-up of 2.7 years, 125 new diagnoses of AD occurred (median time to diagnosis, 4.0 years). Propensity-score–matched analysis and multivariable cox analysis showed that AD was associated with ADT and that risk for developing AD increased with duration of ADT use.