101
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Cherrier MM, Aubin S, Higano CS. Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non-metastatic prostate cancer. Psychooncology 2009; 18:237-47. [PMID: 18636420 PMCID: PMC2853938 DOI: 10.1002/pon.1401] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE Men with prostate-specific antigen (PSA)-only relapse of prostate cancer after primary therapy are generally fully functional and asymptomatic with a life expectancy of up to 10 or more years. Androgen deprivation therapy (ADT) is a common treatment option. This study examined mood and cognitive changes in otherwise healthy men with prostate cancer prior to, during and after ADT. EXPERIMENTAL DESIGN Twenty hormone naïve, eugonadal prostate cancer patients without evidence of metastases and with a rising PSA were treated with intermittent ADT consisting of 9 months of complete androgen blockade (CAB) achieved with combined leuprolide and flutamide followed by an 'off treatment' period. Cognitive function tests and mood measures were administered at baseline, after 3 and 9 months of ADT and after 3 months of no treatment. Twenty healthy control patients without prostate cancer range matched for age and education were tested at the same time intervals. RESULTS ADT patients evidenced a significant decline in spatial reasoning, spatial abilities and working memory during treatment compared with baseline. No changes were noted for measures of verbal or spatial memory, selective attention or language. Significant changes in self-rated mood such as increased depression, tension, anxiety, fatigue and irritability were evident during treatment compared with baseline for ADT patients. No significant changes in either cognitive tests or mood measures were noted for the healthy control group. CONCLUSIONS These findings, suggest that 9 months of combined androgen blockade may result in some adverse changes in cognition and mood. However, many but not all of these changes can return to baseline after cessation of ADT.
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Affiliation(s)
- M M Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98108, USA.
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102
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Abstract
Androgeno-deprivation is the treatment of reference for metastatic prostate cancer but it generates side effects which are too often ignored by physicians due to concentration on hopes of carcinologic benefit. Hot flashes, metabolic syndrome (body mass and lipid changes), decreased libido, erectile dysfunction, anemia, cognitive dysfunction, gynecomastia, decreased muscular mass and osteoporosis are the most frequent symptoms. They can and must be prevented by advice on physical activity and nutrition.
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Affiliation(s)
- T Lebret
- Service d'Urologie, Hôpital Foch, Faculté de médecine Paris-Ile-de-France-Ouest, UVSQ, France.
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103
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104
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Mitsiades N, Correa D, Gross CP, Hurria A, Slovin SF. Cognitive Effects of Hormonal Therapy in Older Adults. Semin Oncol 2008; 35:569-81. [DOI: 10.1053/j.seminoncol.2008.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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105
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Nedelec C, Ragot S, Irani J, Pires C, Gil R, Doré B. [Effects by androgen suppression with luteinizing hormone on cognitive functions in men treated for cancer of prostate]. Prog Urol 2008; 19:47-53. [PMID: 19135642 DOI: 10.1016/j.purol.2008.09.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 09/23/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate secondary effects on cognitive functions as memory and attention impairments in men treated by androgen suppression for cancer of prostate. MATERIAL AND METHODS A prospective study on men treated with luteinizing hormone-realising hormone analogues (LH-RH analogues) for cancer of prostate was designed. Eighteen men were evaluated with cognitive tests as Mini Mental State (MMS), memory evaluation (Grober-Buschke, Rey Test), attention and executive test (Trail Making Test and Montgomery Asberg Depression Rating Scale [MADRS]) before beginning androgen suppression. Base line pretreatment assessments of every patient were compared with similar tests after six and 12 months of hormone therapy. RESULTS On 18 patients, 14 were eligible with pretreatment-median PSA of 22ng/ml (13-659), testosterone of 477ng/dl (398-583), which decreased to 1 and 37ng/dl, respectively. Visual-memory test (Rey test) was significantly improved at M6 (p: 0,001) and M12 (p: 0,02) as was the inversed number-memory test (WAIS) after M6 of androgen suppression and (p: 0,03). CONCLUSION After 12 months of androgen suppression, global cognitive performances were preserved. Our results failed to observe impairment of cognitive function. This deserves more important prospective study.
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Affiliation(s)
- C Nedelec
- Service de neurologie, centre hospitalier de la Rochelle, Poitiers, France
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106
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Mohile SG, Mustian K, Bylow K, Hall W, Dale W. Management of complications of androgen deprivation therapy in the older man. Crit Rev Oncol Hematol 2008; 70:235-55. [PMID: 18952456 DOI: 10.1016/j.critrevonc.2008.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 08/12/2008] [Accepted: 09/03/2008] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer is the most common malignancy in older men. With the aging of the population, the number of older men with prostate cancer will grow rapidly. Androgen deprivation therapy (ADT) is the mainstay of treatment for men with systemic disease and is increasingly utilized as primary therapy or in combination with other therapies for localized disease. Side effects of therapy are multifold and include hot flashes, osteoporosis, and adverse psychological and metabolic effects. Recent research has illustrated that ADT can negatively impact the functional, cognitive, and physical performance of older men. Patients with prostate cancer, despite recurrence of the disease, have a long life expectancy and may be subjected to the side effects of ADT for many years. This review highlights the complications of ADT and approaches to management. We also provide recommendations for assessment and management of ADT complications among the most vulnerable and frail older male patients.
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Affiliation(s)
- Supriya G Mohile
- James Wilmot Cancer Center, University of Rochester, Rochester, NY 14642, USA.
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107
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Flaig TW, Glodé LM. Management of the side effects of androgen deprivation therapy in men with prostate cancer. Expert Opin Pharmacother 2008; 9:2829-41. [DOI: 10.1517/14656566.9.16.2829] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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108
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Abstract
In this article, the literature examining the relationship between testosterone and various cognitive domains in elderly men is reviewed. The review focuses on the role of endogenous testosterone levels and the effects of androgen depletion and replacement. The cognitive domains most commonly linked to testosterone include memory and visuospatial function. Indeed, the literature suggests that in certain conditions (ie, hypogonadism, cognitive impairment) testosterone levels may be significantly associated with memory and visuospatial function, but not other cognitive functions. Studies with larger sample sizes and more sensitive cognitive measures are indicated, as questions remain about the potential role of testosterone as a cognitive enhancer.
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109
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Nelson CJ, Lee JS, Gamboa MC, Roth AJ. Cognitive effects of hormone therapy in men with prostate cancer: a review. Cancer 2008; 113:1097-106. [PMID: 18666210 DOI: 10.1002/cncr.23658] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience several side effects from this treatment. A few recent studies have examined the cognitive implications of ADT and how they impact a patient's treatment decision-making, occupational pursuits, and quality of life. For this report, the authors explored possible mechanisms for this association, reviewed research in animal studies and aging men, and examined the growing literature focused on the relation between ADT and cognitive functioning in patients with prostate cancer. METHODS A systematic literature search was conducted using the PubMed and Information Sciences Institute Web of Knowledge-Web of Science databases to identify relevant studies that investigated the relation between ADT in men with prostate cancer and its cognitive effects. RESULTS Testosterone and its derivatives may have an impact on cognition through several mechanisms in the brain, as supported by studies of animals and in aging men. Studies that researched the impact of ADT on cognition in patients with prostate cancer patients were designed relatively well but suffered from small sample sizes. Between 47% and 69% of men on ADT declined in at least 1 cognitive area, most commonly in visuospatial abilities and executive functioning. Some studies reported contradictory results with increased functioning in verbal memory. CONCLUSIONS There is a strong argument that androgen-ablation therapy is linked to subtle but significant cognitive declines in men with prostate cancer. The authors believe that clinicians should become aware of this correlation as the use of ADT increases and should inform and monitor patients for this possible side effect of treatment.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
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110
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Minisini AM, Pauletto G, Andreetta C, Bergonzi P, Fasola G. Anticancer drugs and central nervous system: Clinical issues for patients and physicians. Cancer Lett 2008; 267:1-9. [DOI: 10.1016/j.canlet.2008.02.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/21/2008] [Accepted: 02/22/2008] [Indexed: 11/16/2022]
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111
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Bryan K, Lee HG, Perry G, Castellani RJ, Smith MA, Casadesus G. Nonestrogen-based hormonal therapies for Alzheimer’s disease. FUTURE NEUROLOGY 2008. [DOI: 10.2217/14796708.3.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Alzheimer’s disease (AD) is becoming increasingly more prevalent worldwide and is a costly, devastating disease. The fact that females are more likely to be diagnosed with AD than men has contributed to the large amount of research and literature on estrogen’s ability to rescue cognitive decline in aging females. However, recent results from the Women’s Health Initiative Memory Study (WHIMS) and the Research into Memory, Brain Function and Estrogen Replacement (REMEMBER) study, in which estrogen-replacement therapy is shown not to be beneficial to cognition in postmenopausal women, especially in women of more advanced ages, have opened the study of hormones and hormone-based therapies beyond that of sex steroids. As such, recent findings, and the focus of this review, indicate that gonadotropins such as luteinizing hormone have a role on cognitive function and AD. It is likely that the interplay of age, and the timing of estrogen and these other less studied hormones will allow us to gain a better understanding of hypothalamic–pituitary–gonadal axis regulation after menopause and how it relates to AD, and will hopefully lead to new avenues of treatment for AD.
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Affiliation(s)
- Kathryn Bryan
- Case Western Reserve University, Department of Neurosciences, 2109 Adelbert Road, Cleveland, OH 44106, USA
| | - Hyoung-gon Lee
- Case Western Reserve University, Department of Pathology, 2109 Adelbert Road, Cleveland, OH 44106, USA
| | - George Perry
- Case Western Reserve University, Department of Pathology, 2109 Adelbert Road, Cleveland, OH 44106, and, University of Texas at San Antonio, College of Sciences, 6900 North Loop, 1604 West San Antonio, TX 78249, USA
| | - Rudy J Castellani
- University of Maryland, Department of Pathology, 22 South Greene Street, NBW81, Baltimore, MD 21201, USA
| | - Mark A Smith
- Case Western Reserve University, Department of Pathology, 2109 Adelbert Road, Cleveland, OH 44106, USA
| | - Gemma Casadesus
- Case Western Reserve University, Department of Neurosciences, 2109 Adelbert Road, Cleveland, OH 44106, USA
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112
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Beasley M, Williams SG, Pickles T. Expanded risk groups help determine which prostate radiotherapy sub-group may benefit from adjuvant androgen deprivation therapy. Radiat Oncol 2008; 3:8. [PMID: 18423030 PMCID: PMC2358899 DOI: 10.1186/1748-717x-3-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 04/18/2008] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess whether an expanded (five level) risk stratification system can be used to identify the sub-group of intermediate risk patients with prostate cancer who benefit from combining androgen deprivation therapy (ADT) with external beam radiotherapy (EBRT). MATERIALS AND METHODS Using a previously validated 5-risk group schema, a prospective non-randomized data set of 1423 men treated at the British Columbia Cancer Agency was assessed for the primary end point of biochemical control (bNED) with the RTOG-ASTRO "Phoenix" definition (lowest PSA to date + 2 ng/mL), both with and without adjuvant ADT. The median follow-up was 5 years. RESULTS There was no bNED benefit for ADT in the low or low intermediate groups but there was a statistically significant bNED benefit in the high intermediate, high and extreme risk groups. The 5-year bNED rates with and without ADT were 70% and 73% respectively for the low intermediate group (p = non-significant) and 72% and 58% respectively for the high intermediate group (p = 0.002). CONCLUSION There appears to be no advantage to ADT where the Gleason score is 6 or less and PSA is 15 or less. ADT is beneficial in patients treated to standard dose radiation with Gleason 6 disease and a PSA greater than 15 or where the Gleason score is 7 or higher.
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Affiliation(s)
| | | | - Tom Pickles
- British Columbia Cancer Agency, Vancouver, Canada
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113
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Wefel JS, Witgert ME, Meyers CA. Neuropsychological sequelae of non-central nervous system cancer and cancer therapy. Neuropsychol Rev 2008; 18:121-31. [PMID: 18415683 DOI: 10.1007/s11065-008-9058-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 03/14/2008] [Indexed: 10/22/2022]
Abstract
Cancer patients report numerous adverse symptoms associated with their disease and treatment including cognitive dysfunction, fatigue, and affective distress. Cognitive dysfunction is ubiquitous in patients with primary central nervous system (CNS) cancer and recent evidence has documented similar deficits in patients with non-CNS cancer as well. Both the cancer itself and treatments including chemotherapy, biological response modifiers, and hormonal therapies have been demonstrated to adversely impact cognitive and neurobehavioral function. Neuroimaging and neurophysiological investigations have likewise revealed alterations in brain function that are helping to account for the nature of these cognitive disorders. Similarly, preclinical animal research is assisting to identify the pathophysiological mechanisms that underlie treatment-related neurotoxicities. The coalescence of multidisciplinary clinical and research efforts hold promise for the development of interventions that may offer neuroprotection in addition to currently available symptomatic therapies and cognitive rehabilitation techniques.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 431, Houston, TX 77030-4009, USA.
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114
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Singer EA, Golijanin DJ, Miyamoto H, Messing EM. Androgen deprivation therapy for prostate cancer. Expert Opin Pharmacother 2008; 9:211-28. [PMID: 18201145 DOI: 10.1517/14656566.9.2.211] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Androgen deprivation continues to play a crucial role in the treatment of advanced and metastatic prostate cancer. In the 65 years since its use was first described, urologists and medical oncologists have developed new and innovative ways to manipulate the hypothalamic-pituitary-gonadal axis with the goal of alleviating symptoms and prolonging the life of men with prostate cancer. Despite the successes that androgen deprivation therapy has brought, each method and regimen possesses unique benefits and burdens, of which the clinician and patient must be cognizant. This review discusses the first-line androgen deprivation methods and regimens presently in use with special attention paid to their side effects and the management of them, as well as the question of when to initiate androgen deprivation therapy.
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Affiliation(s)
- Eric A Singer
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
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115
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Minisini AM, De Faccio S, Ermacora P, Andreetta C, Fantinel R, Balestrieri M, Piga A, Puglisi F. Cognitive functions and elderly cancer patients receiving anticancer treatment: a prospective study. Crit Rev Oncol Hematol 2008; 67:71-9. [PMID: 18394917 DOI: 10.1016/j.critrevonc.2008.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/29/2007] [Accepted: 02/15/2008] [Indexed: 10/22/2022] Open
Abstract
It has been reported that anticancer treatment may cause cognitive impairment. Elderly patients in particular could be at increased risk for treatment-related cognitive deterioration. A consecutive series of cancer out-patients >or=65 years old were prospectively assessed by means of a neuropsychological test Cambridge Cognitive Examination (CAMCOG) test at baseline, and after 3 and 6 months from study entry. Patients were categorized in three groups (group 1, no anticancer treatment; group 2, receiving chemotherapy; group 3, receiving endocrine therapy). Comprehensive geriatric assessment was performed at the three time points evaluation. Sixty-one patients were enrolled (32, 16 and 13, in groups 1, 2, and 3, respectively). At baseline, cognitive function was directly correlated to Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores and was associated with higher educational level and absence of depression. Overall, cognitive function did not worsen across time in each group. However, more patients in the CT group showed worsening in memory skills, and more patients in the ET and CT group experienced reduction in the attention score.
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Affiliation(s)
- Alessandro M Minisini
- Department of Oncology, University Hospital of Udine, Ple SM della Misercordia, 33100 Udine, Italy.
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116
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Affiliation(s)
- Antonio M P Omuro
- Groupe Hospitalier Pitié-Salpêtrière, Federation de Neurologie Mazarin, La Salpêtriere Hospital, Paris, France.
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117
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Abstract
PURPOSE OF REVIEW Androgen deprivation therapy remains the cornerstone of treatment for advanced prostate cancer. There are significant adverse effects associated with prolonged androgen deprivation therapy, with recent findings associating it with the metabolic syndrome and its associated health risks. RECENT FINDINGS A review of the adverse pathologic effects of testosterone deprivation is performed. Recent findings associate androgen deprivation therapy with endocrine and metabolic disarray, specifically the metabolic syndrome, resulting in increased rates of diabetes and myocardial infarction in patients on testosterone deprivation. SUMMARY The increased incidence of the metabolic syndrome in patients receiving androgen deprivation therapy and the associated morbidity and possibly mortality require significant investigation into alternatives to complete testosterone deprivation and ways to counteract these adverse effects.
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118
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Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL. Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther 2007; 87:1325-33. [PMID: 17684084 DOI: 10.2522/ptj.20060302] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Androgen deprivation therapy (ADT) has become an increasingly standard intervention for both early and advanced stages of prostate cancer; however, decreased physical function and hypogonadism have been reported in men receiving ADT. The objectives of this study were: (1) to determine whether ADT (and hypogonadism) resulted in decreased strength and mobility and (2) to examine the effect of ADT on an associated test of cognitive and motor function by assessing visuomotor performance. SUBJECTS AND METHODS Physical function, walking speed, visuomotor performance, gonadal status, body composition, and Comorbidity Disease Index (CMDI) scores were assessed in a cohort of 100 participants that included: (1) men with prostate cancer who were not on ADT, (2) men with prostate cancer who were on short-term ADT (<6 months), (3) men with prostate cancer who were on long-term ADT (> or =6 months), and (4) control subjects who did not have prostate cancer. RESULTS Walking speed varied significantly across the 4 groups, even after adjusting for age, CMDI, and percentage of body fat. Age and CMDI were significantly associated with measurements of physical performance. Adjusted for covariates, men on long-term ADT walked 0.18 m/s slower than the control subjects. Physical function also varied significantly across the 4 groups. Androgen deprivation therapy did not have a significant effect on visuomotor performance. DISCUSSION AND CONCLUSION The results suggest that ADT has a significant effect on walking speed and physical performance in men with prostate cancer.
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119
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Rosario ER, Pike CJ. Androgen regulation of beta-amyloid protein and the risk of Alzheimer's disease. ACTA ACUST UNITED AC 2007; 57:444-53. [PMID: 17658612 PMCID: PMC2390933 DOI: 10.1016/j.brainresrev.2007.04.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/25/2007] [Accepted: 04/27/2007] [Indexed: 01/08/2023]
Abstract
Advancing age is the most significant risk factor for the development of Alzheimer's disease (AD), however the age-related changes that underlie this effect remain unclear. In men, one normal consequence of aging is a robust decline in circulating and brain levels of the sex steroid hormone testosterone. Testosterone depletion leads to functional impairments and increased risk of disease in androgen-responsive tissues throughout the body, including brain. In this review we discuss the relationship between age-related testosterone depletion and the development of AD. Specifically, we focus on androgen regulation of beta-amyloid protein (Abeta), the accumulation of which is a key initiating factor in AD pathogenesis. Emerging data suggest that the regulatory actions of androgens on both Abeta and the development of AD support consideration of androgen therapy for the prevention and treatment of AD.
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Affiliation(s)
- Emily R Rosario
- Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles, CA 90089-0191, USA
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120
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Abstract
The lack of progress concerning the concept of the hot flash experience in men is an indication of the need for exploration of this phenomenon. The hot flash experience in men is a problem that can no longer be ignored. The results of this literature review will provide a foundation for additional development of the concept and facilitate further inquiry into the phenomenon. The purpose of the article is to provide the current state of the science of hot flashes related to androgen ablation treatment in prostate cancer patients; sleep, sweating, cognitive impairment, and the implications on health-related quality of life. Due to the sparse literature on this concept in men, information is extrapolated from the literature on female breast cancer patients treated with hormones and on menopausal women.
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Affiliation(s)
- Christine A Engstrom
- Uniformed Services University of the Health Sciences, Graduate School of Nursing, Bethesda, MD, USA.
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121
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Abstract
PURPOSE/OBJECTIVES To provide a clear definition of the hot flash experience in men with prostate cancer receiving hormonal treatment. DATA SOURCES Articles, book chapters, and electronic sources. DATA SYNTHESIS The hot flash experience has not been explored previously in men with prostate cancer. The physiologic and psychological scopes of the phenomenon are described as a multidimensional experience. CONCLUSIONS The essential attributes of hot flashes in men consist of physiologic (e.g., warmth, sweating, chills) and psychological (e.g., anxiety, impaired memory, agitation) factors. Antecedents to the experience include demographics, disease, and treatment modality. Consequences include effects on sleep, cognition, and health-related quality of life. IMPLICATIONS FOR NURSING Evaluation of the hot flash experience in men receiving hormonal ablation should include assessment of the symptoms associated with the treatment modality and nursing interventions to help ameliorate symptoms. Future research is needed to focus on providing symptom management to decrease the severity or prevent the occurrence of multiple symptoms related to androgen ablation therapy.
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Affiliation(s)
- Christine Engstrom
- Medical Oncology Department, Veterans Administration, Bethesda, MD, USA.
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122
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Rosario ER, Carroll JC, Oddo S, LaFerla FM, Pike CJ. Androgens regulate the development of neuropathology in a triple transgenic mouse model of Alzheimer's disease. J Neurosci 2007; 26:13384-9. [PMID: 17182789 PMCID: PMC6674990 DOI: 10.1523/jneurosci.2514-06.2006] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Normal age-related testosterone depletion in men is a recently identified risk factor for Alzheimer's disease (AD), but how androgen loss affects the development of AD is unclear. To investigate the relationship between androgen depletion and AD, we compared how androgen status affects the progression of neuropathology in the triple transgenic mouse model of AD (3xTg-AD). Adult male 3xTg-AD mice were sham gonadectomized (GDX) or GDX to deplete endogenous androgens and then exposed for 4 months to either the androgen dihydrotestosterone (DHT) or to placebo. In comparison to gonadally intact 3xTg-AD mice, GDX mice exhibited robust increases in the accumulation of beta-amyloid (Abeta), the protein implicated as the primary causal factor in AD pathogenesis, in both hippocampus and amygdala. In parallel to elevated levels of Abeta, GDX mice exhibited significantly impaired spontaneous alternation behavior, indicating deficits in hippocampal function. Importantly, DHT treatment of GDX 3xTg-AD mice attenuated both Abeta accumulation and behavioral deficits. These data demonstrate that androgen depletion accelerates the development of AD-like neuropathology, suggesting that a similar mechanism may underlie the increased risk for AD in men with low testosterone. In addition, our finding that DHT protects against acceleration of AD-like neuropathology predicts that androgen-based hormone therapy may be a useful strategy for the prevention and treatment of AD in aging men.
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Affiliation(s)
| | | | - Salvatore Oddo
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California 92697
| | - Frank M. LaFerla
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California 92697
| | - Christian J. Pike
- Neuroscience Graduate Program and
- Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, and
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123
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Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol 2006; 60:201-15. [PMID: 16860998 DOI: 10.1016/j.critrevonc.2006.06.006] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 05/30/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022] Open
Abstract
Increasing numbers of men with non-metastatic disease are receiving androgen deprivation therapy (ADT) for a variety of indications, some of which are supported by evidence from randomized trials. Balanced against possible survival benefits and better disease control are data that ADT adversely affects quality of life, particularly in the areas of sexual function, physical function, and energy. There is some evidence of worsening upper extremity physical strength but no clear evidence of decline in daily function with ADT. The impact of ADT on cognitive function is not clear at this time. ADT is associated with declines in bone mineral density within 6-12 months of commencing treatment, with increased fracture rates within 5 years of treatment. ADT use is also associated with a 10-15g/L decline in hemoglobin, although the clinical significance of this drop appears to be limited for most patients. It is reasonable for physicians who are about to start men on ADT to obtain a baseline bone mineral density, to counsel them about the impact on sexual function and possible treatments for sexual dysfunction, and to encourage regular exercise. Further insight into adverse effects of ADT and strategies to minimize these adverse effects await data from ongoing studies.
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Affiliation(s)
- Shabbir M H Alibhai
- Division of General Internal Medicine & Clinical Epidemiology, University Health Network, Toronto, Canada.
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124
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Joly F, Alibhai SMH, Galica J, Park A, Yi QL, Wagner L, Tannock IF. Impact of Androgen Deprivation Therapy on Physical and Cognitive Function, as Well as Quality of Life of Patients With Nonmetastatic Prostate Cancer. J Urol 2006; 176:2443-7. [PMID: 17085125 DOI: 10.1016/j.juro.2006.07.151] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE Many patients with prostate cancer receive androgen deprivation therapy for long periods. We compared physical and cognitive function, and quality of life in a cross-sectional study of 57 patients receiving androgen deprivation therapy for nonmetastatic prostate cancer and 51 healthy age matched controls. MATERIALS AND METHODS Physical and daily function were measured by the 6-minute walk test, grip strength, the timed up and go test, and activities of daily living measures. Cognitive function was evaluated by the High Sensitivity Cognitive Screen and by a self-report prototype Functional Assessment of Cancer Therapy cognitive function subscale. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General with the subscale for fatigue and by the Patient-Oriented Prostate Utility Scale. RESULTS Androgen deprivation therapy was given for a median of 1.8 years (range 0.4 to 7.4). Patients had lower median hemoglobin than controls (134 vs 148 gm/l, p <0.0001). Performance on physical tests was similar in the 2 groups. Moderate or severe cognitive impairment by the High Sensitivity Cognitive Screen was similar for patients (23%) and controls (35%, p = 0.2). Self-reported cognitive dysfunction was also similar. Scores for the Functional Assessment of Cancer Therapy-General were similar but the Patient Oriented Prostate Utility Scale summary score was worse for patients (median 71 vs 86, p <0.001). More patients reported severe fatigue (Functional Assessment of Cancer Therapy-Fatigue score less than 35, p = 0.03). Low energy, poor bladder control and loss of sexual function were reported in 36%, 47% and 95% of patients, and in 16%, 34% and 33% of controls, respectively. CONCLUSIONS Patients treated with androgen deprivation therapy experience more symptoms and have worse fatigue than controls, but this study did not detect any effect on physical or cognitive function.
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Affiliation(s)
- F Joly
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
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125
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Abstract
Because many patients who have biochemical relapse will live for many years,preventing additional morbidity in those who are treated with ADT is of the utmost importance. No standard therapy is currently available for men who have biochemical relapse, although data are beginning to show that earlierADT may result in improved survival, at least in patients who have somewhat more advanced disease or rapid PSA doubling times or velocities. Treatment with intermittent ADT may attenuate some of the morbidities, such as loss of bone mineral density. Not all patients will experience all or even many of these complications, but patients can be empowered by learning about these beforehand and under-standing what can be done to prevent, monitor, or treat the side effects. Table 2 summarizes recommendations for baseline evaluations of men prior to initiation of ADT, and Table 3 summarizes interventions for specific complications. Better markers to distinguish patients who will benefit from ADT are needed. Newer hormonal agents or supplements are being researched. In the meantime, patients and the health care team can work together to combat complications related to ADT.
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Affiliation(s)
- Celestia Higano
- Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA 98109, USA.
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126
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Alibhai SMH, Rahman S, Warde PR, Jewett MAS, Jaffer T, Cheung AM. Prevention and management of osteoporosis in men receiving androgen deprivation therapy: a survey of urologists and radiation oncologists. Urology 2006; 68:126-31. [PMID: 16844454 DOI: 10.1016/j.urology.2006.01.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 12/15/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine the current practice of clinicians in the diagnosis and management of osteoporosis among men taking androgen deprivation therapy (ADT), because ADT leads to decreased bone mineral density (BMD) and fractures. METHODS We sent out a survey to Canadian urologists and radiation oncologists. The survey included questions about BMD testing, treatment practices, referral patterns, and risk of osteoporosis. RESULTS The surveys were returned by 170 of 294 respondents (response rate 58%). Few respondents would obtain a baseline BMD in patients starting ADT. Forty percent would order a repeat BMD test after starting ADT if the baseline BMD were normal or unknown, but more than two thirds would if the baseline BMD showed osteoporosis. In men with a normal BMD starting ADT, respondents recommended weight-bearing exercises (58%), calcium (50%), vitamin D (47%), and bisphosphonate (6%) supplements. In men with osteoporosis at baseline, the use of nonprescription therapies increased slightly and bisphosphonate use increased to 44%. If osteoporosis were diagnosed, 11% would treat the patient themselves. The estimated risk of developing osteoporosis within 1 year of starting ADT with a normal baseline BMD ranged from 0% to 90% (median 20%). CONCLUSIONS To our knowledge, this is the first survey of its kind. The key findings included that few physicians would order a baseline BMD test, would prescribe bisphosphonates for prevention but almost one half would consider bisphosphonates to treat established osteoporosis, and wide variations exist in the practice patterns and risk perception surrounding ADT-related osteoporosis. Evidence-based guidelines are needed to help physicians deal effectively with osteoporosis prevention and management among men taking ADT.
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Affiliation(s)
- Shabbir M H Alibhai
- Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Ontario, Canada.
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127
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Green HJ. The context of adjustment: Qualitative reports from Australian men being treated for non-localised prostate cancer. CLIN PSYCHOL-UK 2006. [DOI: 10.1080/13284200410001707533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Heather J. Green
- The University of Queensland , Brisbane, Australia
- LPC-CNRS et Université de Provence 3 , Place Victor Hugo, Marseille, 13331, France
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128
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Gardiner RFA, Nicol DL, Green HJ, Pakenham KI. SIDE-EFFECTS OF TREATMENTS FOR LOCALLY ADVANCED PROSTATE CANCER. BJU Int 2006; 98:229-30. [PMID: 16831173 DOI: 10.1111/j.1464-410x.2006.06357_3.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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129
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D'Amico AV, Kantoff P, Loffredo M, Renshaw AA, Loffredo B, Chen MH. Predictors of mortality after prostate-specific antigen failure. Int J Radiat Oncol Biol Phys 2006; 65:656-60. [PMID: 16682147 DOI: 10.1016/j.ijrobp.2006.01.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Revised: 01/23/2006] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE We identified factors associated with the length of survival after prostate-specific antigen (PSA) failure. METHODS AND MATERIALS The study cohort comprised 81 of 206 men enrolled on a randomized trial evaluating external-beam radiation therapy (RT) with or without androgen suppression therapy (AST) and who experienced PSA failure. Salvage AST was administered at a PSA level of approximately 10 ng/mL as per protocol. Cox regression was used to determine factors associated with length of survival after PSA failure. RESULTS A PSA DT (doubling time) <6 months (p = 0.04) and age at the time of PSA failure (p = 0.009) were significantly associated with length of survival. By 5 years, 35% and 65% of all-cause mortality was from prostate cancer in men whose age at PSA failure was 75 or higher vs. <75, respectively. Across all ages, 0%, 4%, as compared with 63% of men, were estimated to die of prostate cancer within 5 years after PSA failure if their PSA DT was >12, 6-12, or <6 months, respectively. CONCLUSIONS Advanced age and a PSA DT <6 months at the time of PSA failure are associated with a significantly shorter survival.
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Affiliation(s)
- Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
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130
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Holzbeierlein JM. Managing Complications of Androgen Deprivation Therapy for Prostate Cancer. Urol Clin North Am 2006; 33:181-90, vi. [PMID: 16631456 DOI: 10.1016/j.ucl.2005.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
With the increase in the number of prostate cancer cases seen in the United States, the use of androgen deprivation therapy (ADT) as a form of treatment has continued to rise. With the increasing use of ADT, it is important for the urologist to recognize the potential side effects from the use of ADT and ways in which to minimize or eliminate the risks from these side effects. This article describes the potential complications of ADT and the recommendations for treatment or prevention of these complications. In addition,we examine the role of nontraditional forms of ADT and the potential benefits they offer.
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131
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Abstract
Androgen deprivation leads to a profound loss of synaptic density in the hippocampus and changes in learning and memory in animal models. The authors examined group differences in verbal memory between men on androgen deprivation therapy (ADT), a commonly used treatment for prostate cancer, and healthy men. The authors found that men on ADT have a specific impairment of retention but normal encoding and retrieval processes on a word list-learning task. Speed and accuracy for both perceptual and semantic encoding, as well as retrieval at a very short retention interval, were not affected; however, recognition fell to chance after a 2-min retention interval in men on ADT. Healthy men showed only moderate forgetting, and performance was still above chance at 12 min. This pattern of preserved encoding and retrieval but impaired retention suggests that androgens play a role in hippocampally mediated memory processes, possibly having a specific affect on consolidation.
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Affiliation(s)
- Joseph R Bussiere
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239-3098, USA
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132
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Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer. ACTA ACUST UNITED AC 2006; 166:465-71. [PMID: 16505268 PMCID: PMC2222554 DOI: 10.1001/archinte.166.4.465] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. METHODS We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. RESULTS Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22). CONCLUSION Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.
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Affiliation(s)
- Vahakn B Shahinian
- Department of Internal Medicine, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0562, USA.
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133
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Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer. ACTA ACUST UNITED AC 2006. [PMID: 16505268 DOI: 10.1001/.465] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. METHODS We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. RESULTS Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22). CONCLUSION Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.
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Affiliation(s)
- Vahakn B Shahinian
- Department of Internal Medicine, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0562, USA.
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134
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Affiliation(s)
- Lillian M Nail
- School of Nursing, Oregon Health and Science University, Portland, USA.
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135
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Affiliation(s)
- Lillian M Nail
- School of Nursing, Oregon Health and Science University, Portland, USA.
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136
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Matsuda T, Takayama T, Tashiro M, Nakamura Y, Ohashi Y, Shimozuma K. Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients--evaluation of appropriate research design and methodology to measure symptoms. Breast Cancer 2006; 12:279-87. [PMID: 16286908 DOI: 10.2325/jbcs.12.279] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The development of new chemotherapeutic agents and regimens has contributed to reduced risk of cancer recurrence and prolonged patient survival. However, mild cognitive impairment (MCI), also known as ''chemofog'' or ''chemobrain'' following adjuvant chemotherapy for breast cancer has been reported since the late 1980s. Unfortunately, little is known about it's mechanism, type, severity, and episode length. This article reviewed related studies on the subject, and found that chemotherapy-induced MCI appears to occur in 10-40% of patients, and memory loss and lack of concentration are the most frequent symptoms. The symptoms are apparently transient, but take at least several years to disappear. Reviewed studies show a lack of clear understanding of what causes MCI directly. There is also a lack of consistency in symptom measurement. We point to the need to conduct well-designed studies which begin with a proper hypothesis. Future research needs to be randomized and longitudinal with a base measurement point before the chemotherapy cycle starts. Future studies must adopt an effective and sensitive method to measure MCI. The latest imaging technique, positron emission tomography (PET) may be a powerful tool. Also, all confounding factors, such as age, education, intelligence quotient (IQ), fatigue and depression, hormonal therapy and other treatments should be controlled within the study design. It is hoped that the results of such future studies will allow medical professionals to contemplate effective prevention, treatment and rehabilitation for MCI.
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Affiliation(s)
- Tomohiro Matsuda
- Department of Epidemiology, National Institute of Public Health, Wako-shi, Saitama 351-0197, Japan.
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137
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Casadesus G, Webber KM, Atwood CS, Pappolla MA, Perry G, Bowen RL, Smith MA. Luteinizing hormone modulates cognition and amyloid-beta deposition in Alzheimer APP transgenic mice. Biochim Biophys Acta Mol Basis Dis 2006; 1762:447-52. [PMID: 16503402 DOI: 10.1016/j.bbadis.2006.01.008] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 11/17/2022]
Abstract
Until recently, the study of hormonal influences in Alzheimer disease was limited to the role of sex steroids. Despite numerous epidemiological studies supporting a protective role for estrogen in Alzheimer disease, recent studies show that estrogen administration in elderly women increases the risk of disease. Reconciling these contradictory reports, we previously hypothesized that other hormones of the hypothalamic-pituitary-gonadal axis, such as luteinizing hormone, may be involved in the onset and development of the disease. In this regard, luteinizing hormone is elevated in Alzheimer disease and is known to modulate amyloidogenic processing of amyloid-beta protein precursor. Therefore, in this study, to evaluate the therapeutic potential of luteinizing hormone ablation, we administered a gonadotropin-releasing hormone analogue, leuprolide acetate, to an aged transgenic mouse model of Alzheimer disease (Tg 2576) and measured cognitive Y-maze performance and amyloid-beta deposition after 3 months of treatment. Our data indicate that luteinizing hormone ablation significantly attenuated cognitive decline and decreased amyloid-beta deposition as compared to placebo-treated animals. Importantly, leuprolide acetate-mediated reduction of amyloid-beta correlated with improved cognition. Since both cognitive loss and amyloid-beta deposition are features of Alzheimer disease, leuprolide acetate treatment may prove to be a useful therapeutic strategy for this disease.
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Affiliation(s)
- Gemma Casadesus
- Institute of Pathology, Case Western Reserve University, 2085 Adelbert Road, Cleveland, OH 44106, USA
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138
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Affiliation(s)
- Kevin M O'Connor
- Department of Surgery, Mater Misericordiae University Hospital, University College Dublin, Ireland.
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139
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Abstract
Androgen-deprivation therapy (ADT) is indicated for the treatment of metastatic prostate cancer and locally advanced disease. In addition to sexual side effects, long-term ADT results in several other changes, including hot flashes; gynecomastia; changes in body composition, metabolism, and the cardiovascular system; osteoporosis; anemia; psychiatric and cognitive problems; and fatigue and diminished quality of life. This review discusses these complications of ADT and treatments aimed at reducing them. It is important for clinicians to anticipate these effects and to initiate measures to prevent or minimize them in order to maintain quality of life in prostate cancer survivors.
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Affiliation(s)
- Allen C Chen
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB 6-435, New York, NY 10032, USA.
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140
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Janowsky JS. The role of androgens in cognition and brain aging in men. Neuroscience 2005; 138:1015-20. [PMID: 16310318 DOI: 10.1016/j.neuroscience.2005.09.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 08/17/2005] [Accepted: 09/08/2005] [Indexed: 11/17/2022]
Abstract
Losses of working and long-term memory are hallmarks of human aging and may signal impending neurodegenerative disease. The maintenance of neural elements in brain systems that support memory, such as synapse formation in prefrontal cortex and hippocampus, are critical for cognitive health in aging. This paper reviews the biological basis for androgens as neuroprotectants or neuromodulators in aging and the importance of androgens on the brain systems important for memory. We relate biological effects to cognitive outcomes in elderly men under a variety of androgen conditions. In brief, androgen deprivation causes significant loss of synapses in the hippocampus in rodent and nonhuman primates, increases amyloid deposition in human and rodent models and causes changes in neurotransmission in prefrontal cortex in rodent models. Recent work suggests that these changes modify age-related cognitive loss, particularly to memory in men. In addition, the conversion of testosterone to its androgen metabolites or to estradiol may play a special role in the preservation of memory in aging. This paper reviews discrepancies between studies using animal models and studies of human cognition, and suggests new directions that are likely to be fruitful in the future for understanding the role of androgens in brain aging. This review suggests that studies of low androgen levels in older men may not index the same biological mechanisms and behavioral effects as the studies of gonadectomy in animal models.
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Affiliation(s)
- J S Janowsky
- Behavioral Neuroscience, Oregon Health & Science University CR131, Portland, 97239, USA.
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141
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Caparros-Lefebvre D, Dewailly D. Étude pilote préliminaire de l’acétate de cyprotérone dans les comportements agressifs associés aux démences sévères. Rev Neurol (Paris) 2005; 161:1071-8. [PMID: 16288172 DOI: 10.1016/s0035-3787(05)85174-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Behavioral symptoms are common in dementia, and seem to be more frequent in men than in women. Agitation is frequently responsible for caregiver burn-out and leads to institutionalization. The dramatic increase in the prevalence of Alzheimer's disease and related disorders requires better management of behavior symptoms. Although environmental adaptation has been proposed recently, for many years, psychoactive medications and physical restraints were the primary approach. However, in severely demented patients, both pharmacologic and non-pharmacologic treatments are inoperative. In this situation, alternative pharmacologic approach should be tested. Cyproterone acetate, an antiandrogen and progestative steroid has never been proposed to prevent aggressive behavior in dementia, but its favorable effect is well described in rat and monkey aggressivity. PATIENTS AND METHODS Cyproterone acetate was proposed for 19 demented patients who developed severe aggressive behaviors or an agitation unresponsive to psychoactive drugs (even in association) or to environmental adaptation. Clinical and behavioral analysis was carried out using the Cohen-Mansfield agitation inventory associated with an assessment of dependency in daily life activities, before and during treatment with cyproterone acetate. The behavioral status was stable, with permanent or repetitive agitation. Seven patients had vascular dementia, 7 had Alzheimer's disease, 2 had fronto-temporal degeneration, 2 had Huntington's disease and 1 a probable diffuse Lewy bodies disease. Fifteen patients had prominent aggressive behavior and 4 had predominant aberrant motor behavior with aggressive behavior. RESULTS Cyproterone (50 to 100mg - mean: 92.5mg daily) improved significantly aggressive and impulsive behavior related to Alzheimer's disease or vascular dementia but had no effect on aberrant motor behavior. When cyproterone was stopped, aggressive behaviors reappeared more rapidly in vascular dementia. CONCLUSION Cyproterone acetate is then an interesting choice when aggressive behavior is not improved with psychotropic drugs. A detailed clinical analysis is required to avoid the use of cyproterone in non-aggressive and non-impulsive patients. The results of this preliminary study suggest a randomized double-blind study should be carried out in the near future. The behavior improvement could be related to the blockage of androgen receptors, and simultaneously to the sedative effect of progestative drugs.
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142
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Abrahamsson PA, Anderson J, Boccon-Gibod L, Schulman C, Studer UE, Wirth M. Risks and benefits of hormonal manipulation as monotherapy or adjuvant treatment in localised prostate cancer. Eur Urol 2005; 48:900-5. [PMID: 16257109 DOI: 10.1016/j.eururo.2005.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
A round table meeting was held to discuss the role of hormonal therapy in localised prostate cancer. The findings of the group were that immediate hormonal therapy does not provide an overall survival advantage in localised and locally advanced prostate cancer. Bicalutamide can prolong disease free survival in patients with locally advanced prostate cancer, however it is important to underline that at this time it has not been shown to influence disease specific nor overall survival. It remains also unproven that early treatment is superior to treatment at progression. However, a trend towards decreased survival with bicalutamide was observed in low risk patients such as those with localised disease. In patients receiving bicalutamide, there were increased cardiovascular side-effects, in addition to the high incidence of gynaecomastia. Early hormonal therapy has to be balanced against such side-effects and the inevitable appearance of hormone refractory disease in patients who progress after hormonal therapy. Consequently, patients with localised, low risk disease are not considered appropriate candidates for hormonal therapy used either as mono-therapy or in the adjuvant setting.
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Affiliation(s)
- P-A Abrahamsson
- Department of Urology, Malmö University Hospital, Lund University, Sweden.
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143
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Crook TJ, Bramble J. Does neoadjuvant hormone therapy for early prostate cancer affect cognition? results from a pilot study. BJU Int 2005; 96:918; author reply 918-9. [PMID: 16153235 DOI: 10.1111/j.1464-410x.2005.05841_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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144
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Morote J, Esquena S, Orsola A, Salvador C, Trilla E, Cecchini L, Raventós CX, Planas J, Catalán R, Reventós J. Effect of androgen deprivation therapy in the thyroid function test of patients with prostate cancer. Anticancer Drugs 2005; 16:863-6. [PMID: 16096434 DOI: 10.1097/01.cad.0000173474.82486.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have assessed the effect of androgen deprivation therapy (ADT) in the thyroid function test in prostate cancer patients. Serum levels of tri-iodothyronine (T3), thyroxine (T4), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were determined in a cross-sectional study that included 279 patients diagnosed with prostate cancer. A subset of 96 patients free of prostate-specific antigen relapse after radical prostatectomy became a control group and 183 patients under continuous ADT formed the study group. Sixty-four patients out of the study group were treated with luteinizing hormone-releasing hormone (LHRH) agonist and 119 with LHRH agonist plus bicalutamide. The average time of ADT was 42.5 months (3-218). Results were as follows. Mean T3 level was 122.7 ng/dl (72.6-213.0) in the control group and 123.8 ng/dl (64.4-228.2) in patients under ADT, p=0.472. Mean T4 level was 7.66 (1.81-4.30) and 7.66 microg/dl (3.60-13.30), respectively, p=0.884. Mean TSH level was 1.58 (0.44-11.70) and 1.81 mU/dl (0.15-6.58), respectively, p=0.007. Mean FT4 level was 1.24 (0.80-1.90) and 1.18 ng/dl (0.80-1.90), respectively, p=0.018. No statistically significant differences between the T3, T4, TSH and FT4 serum levels were detected according to the modality of ADT. The serum level of TSH was higher than 5 mU/l in six patients (2.1%); however, all cases had a normal FT4 serum level. This mild hypothyroidism was detected in two of the 96 patients of the control group (2.1%) and in four of the 183 under ADT (2.2%). Our data show that ADT seems to alter the thyroid function test. A statistically significant increase in TSH serum level and a decrease in FT4 serum level were detected in patients under ADT. However, only a mild hypothyroidism was detected in about 2% of the patients with prostate cancer, independently of ADT.
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Affiliation(s)
- Juan Morote
- Departments of Urology, Vall d'Hebron Hospital, Autònoma University of Barcelona, Barcelona, Spain.
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145
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Jenkins VA, Bloomfield DJ, Shilling VM, Edginton TL. Does neoadjuvant hormone therapy for early prostate cancer affect cognition? Results from a pilot study. BJU Int 2005; 96:48-53. [PMID: 15963119 DOI: 10.1111/j.1464-410x.2005.05565.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine, in a prospective study, the influence that temporary reversible medical castration for localized prostate cancer has on cognition, by assessing whether temporary 3-5 month treatment with a luteinizing-hormone releasing hormone (LHRH) agonist before radical radiotherapy had a short- or long-term affect on cognitive function. PATIENTS, SUBJECTS AND METHODS Thirty-two patients with localized prostate cancer had cognitive assessments at baseline (T1) before the start of drug treatment, at 3 months (T2) or on completing drug treatment but before radiotherapy, and 9 months later (T3). Eighteen men with no prostate cancer (controls subjects) completed the cognitive tests at the same times. In addition, psychological functioning and quality of life were assessed at the same times, together with serum free and bound testosterone, beta-oestradiol and sex hormone-binding globulin levels. RESULTS There was a significant cognitive decline (on at least one cognitive task) at T2 in 15 (47%) patients vs three (17%) of controls (odds ratio 4.412, P = 0.033). Most patients (nine of 15) who had a change in performance declined on tasks of spatial memory and ability. At T3 there was significant cognitive decline in 11 (34%) patients and five (28%) control subjects (odds ratio 1.37, P = 0.631). CONCLUSION This pilot study suggests that short-term LHRH therapy for early-stage prostate cancer has modest short-term consequences on men's cognitive functioning; a larger prospective study is warranted.
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Affiliation(s)
- Valerie A Jenkins
- Cancer Research UK, Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex, Brighton, UK.
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Wefel JS, Meyers CA. Cancer as a Risk Factor for Dementia: A House Built on Shifting Sand. ACTA ACUST UNITED AC 2005; 97:788-9. [PMID: 15928294 DOI: 10.1093/jnci/dji167] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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147
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Abstract
Hormonal manipulation in the form of androgen-deprivation therapy for prostate cancer was introduced by Huggins and Hodges in 1941 and resulted in a Nobel Prize in 1966. Hormonal therapy initially had been used in metastatic prostate cancer, but the indications have been expanded including failed local therapy, locally advanced prostate cancer, and neoadjuvant or adjuvant therapy in high-risk localized prostate cancer. In view of the magnitude of the problem of prostate cancer and relatively frequent use of hormonal manipulation, it is important for clinicians to be aware of common side effects, prevention, and treatment to improve quality of life and reduce morbidity and mortality in patients with prostate cancer. This review focuses on the common side effects of hormonal treatment such as osteoporosis, anemia, hot flashes, erectile dysfunction, muscle wasting, gynecomastia, decline in cognitive function, depression, increase in body fat and metabolic changes, and their prevention and treatment.
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Affiliation(s)
- Ravi J Kumar
- Urologic Oncology, University of Colorado Health Sciences Center, 4200 East 9th Avenue C-319, Denver, CO 80262, USA.
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148
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Green HJ, Pakenham KI, Gardiner RA. Cognitive deficits associated with cancer: A model of subjective and objective outcomes. PSYCHOL HEALTH MED 2005. [DOI: 10.1080/13548500500093308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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149
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Wilson SS, Crawford ED. Genitourinary malignancies. CANCER CHEMOTHERAPY AND BIOLOGICAL RESPONSE MODIFIERS 2005; 22:485-513. [PMID: 16110626 DOI: 10.1016/s0921-4410(04)22022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Shandra S Wilson
- Department of Urologic Oncology, Anschuz Cancer, Aurora, CO 80010, USA.
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150
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Holzbeierlein JM, McLaughlin MD, Thrasher JB. Complications of androgen deprivation therapy for prostate cancer. Curr Opin Urol 2004; 14:177-83. [PMID: 15069309 DOI: 10.1097/00042307-200405000-00007] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Androgen deprivation as a form of treatment for prostate cancer has been used for decades. Within the last decade, however, there has been a significant increase in its use. Therefore, it is incumbent upon the physician to be familiar with the side effects associated with this treatment. RECENT FINDINGS Some of the side effects such as osteoporosis, changes in lipid profiles, and anemia may have significant morbidity associated with them, while other side effects such as impotence, decreased libido, fatigue, and hot flashes primarily affect the patient's quality of life. Prevention strategies and treatments exist for many of these side effects. SUMMARY This review will update physicians treating patients with androgen deprivation therapy on the side effects associated with this treatment. Once physicians are aware of the potential side effects, they can educate patients on what to expect when starting androgen deprivation therapy. More importantly, physicians can now prevent some of these complications prior to their occurrence, and when these complications occur they have knowledge of the latest treatments.
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