scholarly journals Cognitive decline in patients with prostate cancer: study protocol of a prospective cohort, NEON-PC

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043844
Author(s):  
Natalia Araujo ◽  
Samantha Morais ◽  
Ana Rute Costa ◽  
Raquel Braga ◽  
Ana Filipa Carneiro ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Androgen Deprivation Therapy ◽  
Survival Rates ◽  
Cardiovascular Complications ◽  
Androgen Deprivation ◽  
High Survival ◽  
The Impact

IntroductionProstate cancer is the most prevalent oncological disease among men in industrialised countries. Despite the high survival rates, treatments are often associated with adverse effects, including metabolic and cardiovascular complications, sexual dysfunction and, to a lesser extent, cognitive decline. This study was primarily designed to evaluate the trajectories of cognitive performance in patients with prostate cancer, and to quantify the impact of the disease and its treatments on the occurrence of cognitive decline.MethodsParticipants will be recruited from two main hospitals providing care to approximately half of the patients with prostate cancer in Northern Portugal (Portuguese Institute of Oncology of Porto and São João Hospital Centre), and will comprise a cohort of recently diagnosed patients with prostate cancer proposed for different treatment plans, including: (1) radical prostatectomy; (2) brachytherapy and/or radiotherapy; (3) radiotherapy in combination with androgen deprivation therapy and (4) androgen deprivation therapy (with or without chemotherapy). Recruitment began in February 2018 and is expected to continue until the first semester of 2021. Follow-up evaluations will be conducted at 1, 3, 5, 7 and 10 years. Sociodemographic, behavioural and clinical characteristics, anxiety and depression, health literacy, health status, quality of life, and sleep quality will be assessed. Blood pressure and anthropometrics will be measured, and a fasting blood sample will be collected. Participants’ cognitive performance will be evaluated before treatments and throughout follow-up (Montreal Cognitive Assessment and Cube Test as well as Brain on Track for remote monitoring). All participants suspected of cognitive impairment will undergo neuropsychological tests and clinical observation by a neurologist.Ethics and disseminationThe study was approved by the Ethics Committee of the hospitals involved. All participants will provide written informed consent, and study procedures will be developed to ensure data protection and confidentiality. Results will be disseminated through publication in peer-reviewed journals and presentation in scientific meetings.

Impact of comorbidity and PSA doubling time on the risk of death in men experiencing PSA failure following radiation therapy with or without androgen deprivation therapy for unfavorable-risk prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 68-68
Author(s):  
Sagar Anil Patel ◽  
Ming-Hui Chen ◽  
Marian Loffredo ◽  
Andrew A. Renshaw ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Androgen Deprivation Therapy ◽  
Doubling Time ◽  
Androgen Deprivation ◽  
Psa Doubling Time ◽  
Psa Failure ◽  
Severe Comorbidity ◽  
The Impact

68 Background: The optimal management of men with PSA failure following initial prostate cancer therapy based on comorbidity is unknown. We investigated the impact that PSA doubling time (DT) and comorbidity had on the risk of all cause (AC), prostate cancer-specific (PCS) and other cause mortality (OCM) following PSA failure. Methods: Between 1995 and 2001, 206 men with unfavorable-risk PC were randomized to receive radiation therapy alone or in combination with 6 months of androgen deprivation therapy (ADT). After a median follow up of 16.2 years, 108 men experienced PSA failure (85, no or minimal; 23, moderate to severe comorbidity) and formed the study cohort. Cox and Fine-Gray regression analysis was used to determine whether PSA DT was associated with the risk of ACM and PCSM/OCM respectively, stratified by ACE-27 comorbidity score. Results: After a median follow up of 13.71 years following PSA failure, 81 of the 108 men (75%) died. Longer PSA DT was associated with a decreased risk of PCSM in men with no/minimal (AHR 0.33, 95% CI 0.17-0.65, p= 0.001) and moderate/severe comorbidity (AHR 0.014, 95% CI 0.002-0.129, p= 0.0002) with a trend toward an increased risk of OCM in men with no/minimal (AHR 1.42, 95% CI 0.94-2.16, p= 0.10) and moderate/severe comorbidity (AHR 1.68, 95% CI 0.85-3.35, p= 0.14). However, increasing PSA DT was only associated with a decreased risk of ACM in men with no/minimal (AHR 0.69, 95% CI 0.50-0.96, p = 0.03) but not moderate/severe comorbidity (AHR 0.95, 95% CI 0.51-1.78, p= 0.87). Conclusions: The extent and natural history of comorbidity as well as PSA DT should be taken into consideration when deciding on appropriate management and/or clinical trial eligibility at the time of PSA failure. Specifically, randomized studies are needed to determine whether survival is prolonged in men with life-shortening comorbidity with salvage ADT at the time of PSA failure versus surveillance and reserving ADT use for symptomatic progression. For all other men, trials comparing ADT with or without novel agents shown to prolong survival in men with metastatic castrate resistant PC is warranted.

scholarly journals Course and Predictors of Cognitive Function in Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Controlled Comparison

2015 ◽  
Vol 33 (18) ◽  
pp. 2021-2027 ◽  
Author(s):  
Brian D. Gonzalez ◽  
Heather S.L. Jim ◽  
Margaret Booth-Jones ◽  
Brent J. Small ◽  
Steven K. Sutton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Single Nucleotide ◽  
Impaired Performance ◽  
Genetic Predictors ◽  
The Impact ◽  
Over Time

Purpose Men receiving androgen-deprivation therapy (ADT) for prostate cancer may be at risk for cognitive impairment; however, evidence is mixed in the existing literature. Our study examined the impact of ADT on impaired cognitive performance and explored potential demographic and genetic predictors of impaired performance. Patients and Methods Patients with prostate cancer were assessed before or within 21 days of starting ADT (n = 58) and 6 and 12 months later. Age- and education-matched patients with prostate cancer treated with prostatectomy only (n = 84) and men without prostate cancer (n = 88) were assessed at similar intervals. Participants provided baseline blood samples for genotyping. Mean-level cognitive performance was compared using mixed models; cognitive impairment was compared using generalized estimating equations. Results ADT recipients demonstrated higher rates of impaired cognitive performance over time relative to all controls (P = .01). Groups did not differ at baseline (P > .05); however, ADT recipients were more likely to demonstrate impaired performance within 6 and 12 months (P for both comparisons < .05). Baseline age, cognitive reserve, depressive symptoms, fatigue, and hot flash interference did not moderate the impact of ADT on impaired cognitive performance (P for all comparisons ≥ .09). In exploratory genetic analyses, GNB3 single-nucleotide polymorphism rs1047776 was associated with increased rates of impaired performance over time in the ADT group (P < .001). Conclusion Men treated with ADT were more likely to demonstrate impaired cognitive performance within 6 months after starting ADT relative to matched controls and to continue to do so within 12 months after starting ADT. If confirmed, findings may have implications for patient education regarding the risks and benefits of ADT.

scholarly journals Clinical Utility of miRNA-1, miRNA-29g and miRNA-133s Plasma Levels in Prostate Cancer Patients With High-Intensity Training After Androgen-Deprivation Therapy

2019 ◽  
pp. S139-S147
Author(s):  
A. GAZOVA ◽  
A. SAMAKOVA ◽  
E. LACZO ◽  
D. HAMAR ◽  
M. POLAKOVICOVA ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Composition ◽  
Exercise Training ◽  
Androgen Deprivation Therapy ◽  
Plasma Levels ◽  
Exercise Intervention ◽  
Free Testosterone ◽  
Androgen Deprivation ◽  
Control Group ◽  
The Impact

The randomized trials showed that the addition of training resistance program to androgen-deprivation therapy (ADT) had many beneficial effects for prostate cancer (PC) patients (significant protective effect on the volume of muscle mass) and the studies have revealed a panel of miRNAs, which are deregulate in PC and may serve as promising biomarkers of PC risk. The primary aim of our present study was to investigate the effect of exercise training to changes in body composition (muscle strength) and the secondary endpoint was to investigate the impact of an exercise training program on plasma levels of selected myogenic microRNAs (miRNAs) (miRNA-1, miRNA-29b, and miRNA-133) in PC patients undergoing the ADT. Effect of ADT and exercise intervention showed significant increase (experimental group vs. control group) the changes in body composition, free testosterone levels, IL-6 and plasma levels of myogenic miRNAs and significant reduced insulin serum levels. In conclusion, resistance training with ADT in the treatment of PC significantly changed the physical and metabolic function and the plasma levels of specific myogenic miRNAs. Our data support with the other publicized results.

scholarly journals Decreased Risk of Renal Calculi in Patients Receiving Androgen Deprivation Therapy for Prostate Cancer

2020 ◽  
Vol 17 (5) ◽  
pp. 1762 ◽  
Author(s):  
Chien-Yu Lin ◽  
Jui-Ming Liu ◽  
Chun-Te Wu ◽  
Ren-Jun Hsu ◽  
Wen-Lin Hsu
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Lower Risk ◽  
Propensity Score Analysis ◽  
Renal Calculi ◽  
Androgen Deprivation ◽  
Research Database ◽  
Cox Regression Analysis ◽  
The Impact ◽  
Subsequent Risk

Renal calculi are common, with male predilection and androgen exposure potentially increasing the risk of renal calculi. Systemic effects of androgen deprivation therapy (ADT) have been observed but the influence of ADT on renal calculi in prostate cancer (PCa) patients is not fully understood. We conducted this population-based study to evaluate the impact of ADT on the subsequent risk of renal calculi. We used the National Health Insurance Research Database of Taiwan to analyze the incidences of renal calculi in ADT patients and non-ADT patients from 2001 to 2013. In total, 3309 patients with PCa were selected. After matching with 1:1 propensity-score analysis, 758 ADT patients with 758 matched non-ADT controls were enrolled in the final analysis. Demographic characteristics were analyzed and Cox regression analysis for calculating the hazard ratios (HR) was performed for the subsequent risk of renal calculi. Finally, 186 (186/1516, 12.3%) patients with diagnosed renal calculi were detected. ADT patients had a lower risk of subsequent renal calculi with an adjusted HR of 0.38 (7% vs. 17.5%, 95% confidence interval (CI) 0.28–0.53; p < 0.001) in comparison with the non-ADT group. The Kaplan–Meier curve showed significant differences of cumulative incidences of renal calculi. In conclusion, ADT patients had approximately one-third lower risk of subsequent renal calculi. Further studies are warranted to evaluate the clinical significance.

Prevention of hip fractures in older men receiving androgen deprivation therapy for prostate cancer: A cost-effectiveness analysis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6530-6530
Author(s):  
K. Ito ◽  
E. Elkin ◽  
M. Morris
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Androgen Deprivation Therapy ◽  
Hip Fractures ◽  
Androgen Deprivation ◽  
Mineral Density ◽  
T Score ◽  
Model Based ◽  
Screening Cost ◽  
The Impact

6530 Background: Androgen deprivation therapy (ADT) increases the risk of osteoporotic fractures. Our goal was to assess the cost-effectiveness of bone mineral density (BMD) screening followed by alendronate therapy at the onset of ADT in men with T2c-T4N0 prostate cancer. Methods: We developed a Markov model of prostate cancer progression and simulated the experience of 70-year-old men with T2c-T4N0 prostate cancer starting a 2-year course of ADT after radiation therapy. We compared four strategies: No BMD screening and no alendronate therapy; BMD screening with alendronate therapy for men with osteoporosis (a T-score ≤ -2.5); BMD screening with alendronate therapy for men with osteoporosis or osteopenia (a T-score ≤ -1.0); and universal alendronate therapy without BMD screening. The main outcome measure was cost per quality-adjusted life year (QALY) gained. Data sources were U.S. epidemiological studies and health care cost figures. A model-based estimate of median survival was 9.5 years. Proportions of men who had a T-score ≤ -2.5 and -1.0 were 10% and 45%, respectively. A model-based incidence of hip fractures with no therapy was 0.93 per 100 person-years. Alendronate reduced the risk of hip fractures by 10%. Results: Compared with no screening and no therapy, BMD screening with alendronate therapy for men with osteopenia or osteoporosis cost $66,100 per QALY gained. BMD screening with alendronate therapy only for those with osteoporosis was slightly more costly and more effective, but had a less favorable ICER. Universal alendronate therapy without screening cost $1,580,300 per QALY gained. These results were most sensitive to assumptions about the impact of alendronate on the rate of BMD loss during ADT and the price of alendronate. Conclusions: In men with T2c-T4N0 prostate cancer, BMD screening with alendronate therapy for men with osteoporosis or osteopenia is a cost-effective use of resources, compared with other medical interventions in oncology. [Table: see text] No significant financial relationships to disclose.

Prevalence of overweight and prediabetes in men receiving systemic therapies for metastatic prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 289-289 ◽  
Author(s):  
Warner Finstad ◽  
Raimundas Galiauskas ◽  
James Cook ◽  
Kate Murphy ◽  
Derbrenn O'Connor ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Steroid Therapy ◽  
Metastatic Prostate Cancer ◽  
American Diabetes Association ◽  
Androgen Deprivation ◽  
Treatment Type ◽  
The Impact ◽  
Systemic Therapies

289 Background: Patients with metastatic prostate cancer receive several therapies which may be associated with a tendency to overweight and impaired glucose tolerance. These include androgen deprivation therapy and long term steroid therapy. We set out to assess the prevalence of overweight and diabetes/prediabetes in a cohort of patients attending an oncology day ward for a variety of systemic therapies. Methods: We performed a retrospective review of the medical records of men attending an oncology day ward for prostate cancer treatment. As part of their usual care, these men had regular height and weight checks and also had periodic hemoglobin A1C (HbA1C) measurements performed. The prevalence of prediabetes and diabetes in this patient population was assessed from the HbA1C results using the American Diabetes Association 2016 definitions. Information on patient steroid use (and type), and treatment type were also recorded. Results: Among 34 men with metastatic prostate cancer, the mean age was 74 (range 57-88). Therapies received included androgen deprivation therapy in all cases, with chemotherapy or novel androgen receptor pathway inhibitors such as abiraterone and enzalutamide. Only 12% had a pre-existing diagnosis of diabetes mellitus (all type 2). The majority (79%) are overweight or obese. 59% have pre-diabetes as per the American Diabetes Association 2016 Guidelines, while a further 24% meet criteria for diabetes. Only 18% have HbA1c in the normal range. 56% are on continuous long term steroid therapy, usually as part of their prostate cancer therapy. A further 23% receive intermittent steroids. Only 21% had received no steroids in the 6 months prior to first HbA1C check. 18% had castrate-sensitive disease and 82% had castrate resistant disease. Even among patients with castrate sensitive disease, 2/3 had abnormal HbA1c values. Conclusions: Overweight and prediabetes are very prevalent in men receiving systemic therapies for metastatic prostate cancer. A large percentage of men are on long-term steroid therapy which may be contributing to their risk of these conditions. Intervention is required for this group of patients to reduce the impact of therapy on cardiovascular and overall health.

Addition of docetaxel or abiraterone to androgen deprivation therapy in metastatic castration-naive prostate cancer in South Asian population.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16514-e16514
Author(s):  
Neha Sonthwal ◽  
Shaik Maheboob Hussain ◽  
Devavrat Arya ◽  
Sandeep Batra ◽  
Harit Kumar Chaturvedi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
South Asian ◽  
Asian Population ◽  
Androgen Deprivation ◽  
Outcome Analysis ◽  
Serological Response ◽  
South Asian Population ◽  
To Receive

e16514 Background: Clinical trials have shown that addition of Docetaxel or Abiraterone to androgen deprivation therapy (ADT) achieves superior survival outcome in metastatic castration naive prostate cancer (mCNPC) in predominantly western population. We sought to evaluate treatment outcomes of adding Docetaxel or Abiraterone to ADT in South Asian population. Methods: 90 mCNPC patients who received treatment between January 2015 and June 2018 were prospectively followed. Diagnosis was established by TRUS guided prostate biopsy and staging was done by Ga68 PSMA PET CT scan in all patients. Patients who were unfit for combination therapy received ADT alone. Patients diagnosed before June 2017 & fit to receive chemo-hormonal therapy, received ADT+Docetaxel. Patients diagnosed after June 2017 and fit to receive combination were offered ADT+Docetaxel or ADT+Abiraterone and therapy selected based on patient’s choice. Monthly clinical evaluation and PSA measurement was done. Outcome measures analyzed included PSA decline > 90%, serological complete response (PSA < 0.2 ng/ml) and progression to CRPC. 76 patients with atleast 6 months follow-up were included in outcome analysis. Results: Patients received ADT alone (N = 37) or ADT+Docetaxel (N = 31) or ADT+Abiraterone (N = 22). Median age was 72, 64 & 70 years, median PSA was 88, 95 & 38 ng/ml, Gleason score was ≥8 in 57%, 71% & 77% patients in ADT alone, ADT+Docetaxel & ADT+Abiraterone group, respectively. Bone & visceral metastasis were present in 62% & 24%, 74% & 26%, 68% & 23% patients in ADT alone, ADT+Docetaxel & ADT+Abiraterone group, respectively. Outcome analysis in 76 evaluable patients is shown in Table. Conclusions: ADT+Docetaxel & ADT+Abiraterone achieve deeper serological response and reduced progression to CRPC compared to ADT alone in metastatic castration naive prostate cancer patients with South Asian ethnicity. Longer follow up is required to comment on overall survival and also to determine which combination (ADT+Docetaxel or ADT+Abiraterone) is superior to other, if at all.[Table: see text]

scholarly journals Role of Androgen Deprivation Therapy for Node-Positive Prostate Cancer

2009 ◽  
Vol 27 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Yu-Ning Wong ◽  
Stephen Freedland ◽  
Brian Egleston ◽  
Gary Hudes ◽  
J. Sanford Schwartz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Androgen Deprivation Therapy ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Regional Lymph Nodes ◽  
Node Positive ◽  
Survival Difference ◽  
Significant Difference ◽  
The Impact

Purpose To determine the impact of adjuvant androgen deprivation therapy (ADT) for patients who have node-positive prostate cancer in the prostate-specific antigen (PSA) era. Patients and Methods We used linked Surveillance, Epidemiology and End Results-Medicare data to construct a cohort of men who underwent radical prostatectomy (RP) between 1991 and 1999 and who had positive regional lymph nodes. We classified men as receiving adjuvant ADT if they received ADT within 120 days of RP, and we compared them to the men who had not received adjuvant ADT. We used propensity scores to balance potential confounders of receiving adjuvant ADT (ie, tumor characteristics, extent of nodal disease, demographics, receipt of radiation therapy) and Cox proportional hazard methods to measure the impact of adjuvant ADT on overall survival (OS), stratified by propensity score quintile. We conducted a sensitivity analysis that used 90, 150, 180, and 365 days as the definition for adjuvant ADT. Results A total of 731 men were identified, 209 of whom received ADT within 120 days of RP. There was no statistically significant difference in OS between the adjuvant ADT and non-ADT group (HR, 0.97; 95% CI, 0.71 to 1.27). There was no statistically significant survival difference with 90, 150, 180, and 365 days as the adjuvant ADT definition. Conclusion Deferring immediate ADT in men with positive lymph nodes after RP may not significantly compromise survival. Because observational studies should be considered hypothesis-generating studies, these results should be validated in a prospective fashion in a similar patient population.

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