There is good reason, now, it appears, for men with advanced (metastatic) prostate cancer to prepare for possible Alzheimer's disease if they need to go on hormone treatment - -which most will. There are, of course, different stages, even for metastatic disease in which the prostate cancer cells have migrated into bones (see graphic above). The 'trick' is knowing when to begin. The advice of Hopkins oncologist Dr. Patrick Walsh has consistently been don't start too early - especially if there are no manifest symptoms (i.e. blood in urine or stool, blockage of urination, extreme bone pain in spine, pelvis, limbs).
For me right now, diagnosed with "castrate-resistant metastatic disease" I am still at the cusp of any firm decision given the degree of metastasis has not yet reached the bones. It has, however, reached the lymph nodes, e.g.
PSMA Scan Confirms Cancer Is Metastatic (As Well As Localized)
However, a 2019 study out of the University of Pennsylvania’s Perelman School of Medicine supports this recommendation of delay by Dr. Walsh. The study in JAMA Network Open, e.g.
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 including 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, did point out 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.”
That means preparing for the worst. A recent issue of The Cleveland Clinic Men's Health Advisor went into such preparation in detail, and I am now examining it and preparing Janice as well with the information. Basically, there are three stages: early, middle and late. The early (and at least part of the middle) coincide with the brain changes associated with the "mild" form. The late stage always coincides with the severe disease and is usually that phase where the person must go into a total care environment.
The Cleveland Clinic NL distinguishes the phases thusly:
Early: Trouble remembering names or recent information, including what one may have read on a news website or blog. Difficulty in choosing the right word when writing or speaking in conversation. Difficulty taking medications, managing finances, operating appliances, TV remotes etc.
Middle: Confusion in finding directions one may have had no problem with before. Chronic forgetfulness including leaving keys at home, misplacing car keys, misplacing credit cards, leaving oven or stove on. Inability to recall personal information: e.g. address, phone number, educational background, work experience etc. Difficulties with personal hygiene - shaving, bathing, dental care.
Late: Loss of all bladder and bowel control, inability to find one's way around the home, severe mental misfires, i.e. putting car keys in the freezer, mistaking dog food for human food. Loss of language, communication ability, reduction in motor skills, difficulty in swallowing, increased susceptibility to infections.
Once the advanced prostate cancer patient on ADT enters the middle phase it is time to prepare the following:
1- Review short term and long term caregiving needs and options with family.
2- Enlist community services for housework, meal preparation, bathing and hygiene assistance, transportation.
3- Complete advanced directives: living will, durable power of attorney for finances, healthcare proxy designation.
According to the Cleveland Clinic NL, the average length of time patients have left following initial diagnosis is "4 to 9 years." Meaning it becomes a race between the cancer and Alzheimer's disease as to which will put the guy 6' under first.
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