I just cannot remember where I put my keys. What is my home telephone number? What is his name, you know the guy I sit next to everyday in the office?

Sound familiar, maybe because you are on hormone deprivation therapy (ADT) to treat your advanced prostate cancer. This can explain why your normally intact cognition has declined.

In reality little is known about the effect of ADT on the brain despite the fact that your brain is full of sex steroid receptors in cortical brain regions that mediate memory and other cognitive functions.

Beer etal. Decided to look at the effect of ADT on cognition. They evaluated long-term memory (immediate and delayed paragraph recall tests), working memory (SOP and Trails tests) and Profile of Mood States were assessed at baseline and 4 weeks later in 18 men with androgen independent prostate cancer beginning second line hormonal therapy with transdermal estradiol 0.6 mg/24 hours. The same assessments were performed in 2 age matched control groups of 18 men with prostate cancer undergoing ADT continuing on hormonal therapy and 17 healthy control men.

No surprises here, they found that the immediate and delayed verbal memory were significantly worse in men with prostate cancer on androgen deprivation than in age matched healthy controls. In addition, men with prostate cancer took more time to complete the Trails A task, indicating slower processing speed, but did not differ significantly from healthy controls in working memory tasks. In individual repeated measures analyses, verbal memory performance improved with estradiol therapy but did not change in the 2 control groups.

So, what does this mean? Sex steroid loss and replacement have effects on specific cognitive processes in older men. Furthermore, estrogen has the potential to reverse the neurotoxic effect.

Testosterone loss and estradiol administration modify memory in men, J Urol. 2006 Jan;175(1):130-5. Beer TM, Bland LB, Bussiere JR, Neiss MB, Wersinger EM, Garzotto M, Ryan CW, Janowsky JS.Department of Medicine, Division of Hematology and Medical Oncology, OregonHealth and Science University, Portland, Oregon, USA.

Joel T. Nowak, M.A., M.S.W.