Latest Medical Finding: Hormone Treatments Put Prostate Cancer Patients At Higher Risk Of Alzheimer's Disease

PET-scan showing extent of bone metastases in a prostate cancer patient. Each dark area represents actual prostate cancer cells, i.e. in the spine, pelvis, neck etc.  Such evidence would definitely indicate the need to begin ADT or other hormone therapy.

As I noted in my June 3rd post, as a prostate cancer survivor unsure of how many years he has left, or what the disease is doing now (though the last PSA test did how the velocity slowing  from 0.21 ng/ml / mo. to 0.12 ng/ml/ mo.) I am trying to take an open minded approach combined with a realistic one.  Basically this means (and my wife and primary care doc agree) postponing any hormone treatments until I become symptomatic.   This decision actually was based on advice from leading Hopkins urologist Patrick Walsh, in his book Dr. Patrick Walsh’s Guide To Surviving Prostate Cancer’.


Therein he wrote (p. 338):

"If you have metastases to bone, bone pain, or a large mass of cancer that is obstructing your kidneys or bladder, you need to start ADT right now.    In this situation it's the right course of action - one that can make a huge difference in your quality of life and can protect your body from the ravages of cancer.

But what if you have no cancer in your bones  and no sign that anything is wrong except a rising PSA level after surgery or radiation - or the presence of cancer in your lymph nodes- and you feel fine?   Many doctors would advise you to start hormonal therapy as soon as possible.  Others - and I'm in this group - believe that in most cases there is no evidence that starting hormonal therapy immediately, as opposed to later, will prolong life.

Hormonal therapy does two things: it stops cells from making PSA, and it shrinks the hormone sensitive cell population.  Thus, a man's PSA falls and it takes longer for his bone scan to become positive for metastases.  But it doesn't stop the clock. The hormone insensitive cells keep right on growing silently."

The last sentence makes an important point, and as Dr. Dr. Walsh goes on to elaborate:

“A drug or hormone therapy that targets only one kind of cell won’t have any effect against another variety so the one size fits all approach doesn’t work here. Plus some of these cells have learned to be resistant and to grow in the absence of male hormones…so the drop in PSA may be misleading. These are called androgen independent or androgen sensitive cells.” 

 Adding:

“When male hormones are shut off, the PSA making process may indeed stop, but this doesn’t mean the cancer cells are dead or have stopped growing.”

Now, a study out of the University of Pennsylvania’s Perelman School of Medicine supports this recommendation by Dr. Walsh.  The study, in JAMA Network Open, included 154,089 men whose average age was 74 and who had diagnoses of prostate cancer. Of these, 62,330 received ADT  and the rest did not. The study found a link between drugs commonly used for hormone therapy and an increased risk of developing dementia.as well as Alzheimer's disease.

The study adjusted for socioeconomic status, age, race, severity of prostate cancer and other factors.

The lead author, Ravishankar Jayadevappa, an associate professor at the University of Pennsylvania Perelman School of Medicine, said that for advanced cancer, ADT. can be a lifesaving treatment and should not be avoided because of any increased risk for dementia. But, he said, “Patients with localized cancer should be looking at the risks of dementia, and possibly avoiding A.D.T.”

I totally concur with that but with the additional proviso: that patients with NO  evident symptoms should also be looking at the risks, and not just from cognitive disability.  With diabetes running in my family, and having seen its ravages, I can't simply adopt a therapy to fight a cancer while not recognizing the other - perhaps greater- threat.   (Currently, through the use of diet I am keeping the a1c and blood glucose under relative control, but it's still rated as "pre-diabetic")

Back to the UPenn study:  In an average follow-up of eight years, the scientists found that compared with men who had no hormone therapy, one to four doses of ADT was associated with a 19 percent increased risk for both Alzheimer’s disease and other forms of dementia, and the risk increased with the number of doses. At five to eight doses the increased risk was 28 percent for Alzheimer’s and 24 percent for other dementias.  Since most advanced prostate cancer patients are given doses every 6 months, and this could go on easily for 5 or more years, that threshold is easily crossed.

Further, the  University of Pennsylvania researchers found that 22-percent of prostate cancer patients who received ADT were later diagnosed with dementia compared to 16-percent who did not receive ADT. As well, 13-percent of ADT recipients developed Alzheimer’s disease compared to 9-percent who did not receive the hormone therapy.

Though this hormone-blocking therapy - first discovered in the 1940s -  has been proven highly effective for slowing prostate cancer, it comes with a number of risk factors including:  increased risk of depression, strokes, diabetes, cardiovascular disease, bone density loss (with attendant fractures)  and progressive cognitive decline.

The UPenn study was cited by at least one member of the prostate cancer survivor's group to which I belong, as he wrote:

"This study has convinced me that I'd rather die from prostate cancer than take ADT overly long and get dementia or Alzheimer's!"

An extreme statement but I agree with him, after seeing the ravages of Alzheimer's and dementia on three close family members (Krimhilde, my sister-in-law, the most recent).  So, as I told my primary doc I plan to postpone beginning ADT until I become symptomatic, and then plan to cut it off after  6- 12 months by which time the most PCa grievous symptoms should subside and before profound cognitive incapacity arises.

This news is definitely a wake up call for prostate cancer patients, many of whom are pushed into hormone therapies much too early - and often as an accompaniment of other treatments, i.e. radiation.

See also:

https://www.youtube.com/watch?v=KtIfsvQh2qI

And:

https://www.pcf.org/c/adt-what-you-really-need-to-know/