Cognitive and Psychological Impacts of Different Treatment Options for Prostate Cancer: A Critical Analysis

Objectives: Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options. Methods: Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed. Results: A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent. Conclusion: Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short- and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties.

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

BMJ Open ◽

10.1136/bmjopen-2020-043844 ◽

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.

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Androgen deprivation therapy and radiation for prostate cancer—cognitive impairment, sleep, symptom burden: a prospective study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003098 ◽

2021 ◽

pp. bmjspcare-2021-003098

Author(s):

Joshua Tulk ◽

Joshua A Rash ◽

John Thoms ◽

Richard Wassersug ◽

Brian Gonzalez ◽

...

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Androgen Deprivation Therapy ◽

Sleep Onset ◽

Symptom Burden ◽

Physical Symptoms ◽

Androgen Deprivation ◽

Self Report ◽

Subjective Cognitive Decline ◽

Subjective Time

ObjectivesThis paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI.MethodsThis prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (dc).ResultsMen with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change.ConclusionsSubjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.

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Cognitive impairment and associations with structural brain networks, endocrine status, and risk genotypes in patients with newly diagnosed prostate cancer referred to androgen‐deprivation therapy

Cancer ◽

10.1002/cncr.33387 ◽

2020 ◽

Author(s):

Cecilie R. Buskbjerg ◽

Robert Zachariae ◽

Simon Buus ◽

Claus H. Gravholt ◽

Lene Haldbo‐Classen ◽

...

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Androgen Deprivation Therapy ◽

Brain Networks ◽

Androgen Deprivation ◽

Newly Diagnosed ◽

Endocrine Status ◽

Structural Brain

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Adverse effects of androgen deprivation therapy on cognitive impairment for men with prostate cancer: A meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16506 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16506-e16506

Author(s):

Maxine Sun ◽

Alexander P Cole ◽

Nawar Hanna ◽

Quoc-Dien Trinh

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Androgen Deprivation Therapy ◽

Prospective Studies ◽

Meta Analysis ◽

Case Control ◽

Androgen Deprivation ◽

Cochrane Library ◽

Retrospective Data ◽

Case Control Studies

e16506 Background: Use of androgen deprivation therapy (ADT) may confer a higher risk of cognitive impairment. Published results are variable and lack consensus. Our objective was to perform meta-analysis of the risk of overall cognitive impairment in men receiving ADT for prostate cancer. Methods: Relevant studies were identified through the search of English language articles indexed in PubMed Medline, PsycINFO, Cochrane Library and Web of Knowledge/Science until December 21st2016. Articles were included if they were published in English, reported on original research with adult male subjects undergoing treatment for prostate cancer, incorporated longitudinal comparisons, and included a control group. Controlled intervention studies were required to assess an established cognitive-related endpoint that was measured by a validated instrument, and measure cognitive impairment based on the International Cognition and Cancer Task Force (ICCTF) criteria. The effect of ADT on cognitive impairment was pooled using a random-effects model for controlled intervention and case-control studies separately. Results: Of 221 abstracts, 25 were selected for full-text review, and 8 studies, with 2 controlled studies and 6 case-control studies were identified. Overall cognitive impairment was not significantly different when the results of the 2 prospective studies were pooled (OR: 1.57, 95% CI: 0.50–4.92, P= 0.44), with significant heterogeneity between estimates ( I2: 83%). In retrospective data, the odds of developing any cognitive impairment were significantly higher in men treated with ADT (HR: 1.37, 95% CI: 1.06–1.77, P= 0.02), with considerable heterogeneity ( I2: 84%). Conclusions: The relationship between overall cognitive impairment and use of ADT defined according to the ICCTF criteria in a pooled-analysis of two prospective studies was inconclusive. Although retrospective studies suggest a higher risk of overall cognitive impairment after ADT, we caution readers not to over-interpret this finding given the limitations of retrospective data. Better well-designed prospective studies are needed to assess the effect of ADT on cognitive impairment with long-term follow-up.

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Brain morphological features and cognitive impairment in prostate cancer patients with chronic androgen deprivation therapy

European Urology Supplements ◽

10.1016/s1569-9056(18)30926-6 ◽

2018 ◽

Vol 17 (2) ◽

pp. e108

Author(s):

A.C. Plata Bello ◽

Y. Pérez Martin ◽

J.M. Perez González ◽

J.L. González Mora ◽

T. Concepción Masip ◽

...

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Morphological Features

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Intermittent Androgen Deprivation Therapy—An Important Treatment Option for Prostate Cancer

JAMA Oncology ◽

10.1001/jamaoncol.2016.3138 ◽

2016 ◽

Vol 2 (12) ◽

pp. 1531 ◽

Cited By ~ 9

Author(s):

Laurence Klotz ◽

Celestia S, Higano

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Treatment Option ◽

Androgen Deprivation

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Androgen Deprivation Therapy Use and Risk of Mild Cognitive Impairment in Prostate Cancer Patients

Alzheimer Disease & Associated Disorders ◽

10.1097/wad.0000000000000415 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Hector Alonso-Quiñones ◽

Bradley J. Stish ◽

Jeremiah A. Aakre ◽

Clinton E. Hagen ◽

Ronald C. Petersen ◽

...

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation

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Localized and Locally Advanced Prostate Cancer: Treatment Options

Oncology ◽

10.1159/000513258 ◽

2021 ◽

pp. 1-9

Author(s):

Vérane Achard ◽

Cédric Michael Panje ◽

Daniel Engeler ◽

Thomas Zilli ◽

Paul Martin Putora

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Androgen Deprivation Therapy ◽

Advanced Prostate Cancer ◽

Treatment Options ◽

Locally Advanced ◽

Androgen Deprivation ◽

Locally Advanced Prostate Cancer ◽

Risk Patients

Background: There are many treatment options for localized and locally advanced prostate cancer with radiotherapy and surgery representing the main local therapeutic strategies. Summary: Depending on the risk of disease recurrence, we can stratify patients into low-, intermediate- and high-risk groups, which will guide patients’ treatment. For low-risk patients, active surveillance is an option. Brachytherapy is also an option for low- and intermediate-risk patients and can be used as a boost following external beam radiotherapy for high-risk patients. For intermediate- and high-risk patients, radical prostatectomy and radiotherapy should be considered. Moreover, in addition to radiotherapy, concomitant androgen deprivation therapy may be needed. Finally, after radical prostatectomy and depending on pathological, biological and clinical factors, radiotherapy ± androgen deprivation therapy can be proposed as an adjuvant or salvage treatment. Key Messages: With radiotherapy and surgery being well-established treatment options for localized prostate cancer patients with equally good overall survival rates, priority must be given to patients’ choice concerning the logistics and the toxicity profile of each option.

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Multimodal therapy for the treatment of fatigue in patients with prostate cancer receiving androgen deprivation therapy and radiation.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.tps9650 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. TPS9650-TPS9650

Author(s):

Sriram Yennurajalingam ◽

Cindy Carmack ◽

Karen Basen-Engquist ◽

James M. Reuben ◽

Eduardo Bruera

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Inflammatory Cytokines ◽

Depressed Mood ◽

Treatment Options ◽

Depression Scale ◽

Androgen Deprivation ◽

Post Intervention ◽

To Receive

TPS9650 Background: Cancer-related fatigue (CRF) is the most frequently reported symptom associated with cancer and its treatment. Unfortunately, there are limited treatment options to alleviate this distressing symptom. Preliminary data suggest that the combination of exercise, cognitive behavioral therapy (CBT), and methylphenidate (that is, multimodality therapy [MMT]) can play an important role in reducing CRF. The project’s objective is to explore the effects and safety of this MMT on CRF in prostate cancer patients scheduled to receive radiotherapy with androgen deprivation therapy. We hypothesizethat the MMT is capable of reducing CRF as measured by the FACIT-F subscale in prostate cancer patients scheduled to receive radiotherapy. Specific Aims:(1) Our primary aim is to obtain preliminary estimates of the effects of various treatments (exercise, CBT, and methylphenidate) and their combinations in reducing CRF in prostate cancer patients receiving radiotherapy, as measured by the change in patients’ FACIT-F subscale scores taken at baseline and on day 57 and the secondary objective is to determine the effects of the treatments and their combinations on anxiety and depressed mood (both measured by the Hospital Anxiety Depression Scale [HADS]); on physical activity and function (measured by an accelerometer and a handgrip dynamometer, respectively); on levels of inflammatory cytokines (IL-1β, IL-6, TNF-α, and IL-10) in serum and induced monocytes, before and after treatment Methods: For this study, we will use a randomized factorial design to assess 3 treatments (exercise, CBT, and methylphenidate) and their placebos in 8 replications. A total of 32 patients will receive each primary treatment and 32 will not. Patients will be studied for a 57-day period, during which they are scheduled undergo daily radiation treatments with androgen deprivation therapy. Fatigue, anxiety and depressed mood, and inflammatory cytokines will be determined at baseline and at 3 subsequent post-intervention assessments. After successful initiation so far 19/64 patients were enrolled. Accrual continues. Clinical trial information: NCT01410942.

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