I want to tell you about a man named Joel who started hormone therapy (ADT) and could not remember who he was, or were he lived. He was brought up in born in New York City and lived the majority of his life in the city. He never took taxis, but almost always relied on the subway. Then, one day, while in the subway, he could not remember where he was trying to go, where he lived and how to get there!

So he used his cell phone, thanks you memory dial, and called home. They told him where he lived and to find the sign that read Brooklyn and get on that train. Great, he felt much better, but where was that Brooklyn train hiding? H looked and looked, but no where was that train to be found. Now, Joel is not above asking for directions when he gets really desperate so he went over to another person on the platform and asked for help. The tourist he asked pointed to the sign above his head that read, “Brooklyn, Downtown.” That tourist quickly “walked” away shaking his head.

I am glad to report that Joel did get on the train and that he did make it home. He never did remember why he was in the subway and where he was planning to go. I guess it wasn’t that important.

This was a true story, one of many that describe my memory and ability to concentrate while on hormone therapy. I could tell you about the fact that this former voracious reader eventually went to the bookstore to buy a boy’s adolescent adventure novel so that I would have something to read that I could understand. Each night, before going to bed, I read the same 5 of 6 beginning chapters of that book. Each night the story was exciting and new. Boy, did I get an excellent value for my $9.95. I read that same book for five months and never became bored; I also never made it beyond the first chapters.

The Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center just completed a study on the studies of men on androgen-deprivation therapy (ADT). They found that there are only a few recent studies that examine the cognitive implications of ADTon men being treated for prostate cancer.

They conducted a literature search using the PubMed and Information Sciences Institute Web of Knowledge-Web of Science databases to identify other studies that examined the relation between ADT in men with prostate cancer and its cognitive effects.

They concluded that testosterone and its derivatives may have an impact on cognition through several mechanisms in the brain. These conclusions were supported by both studies of animals and in aging men. They also concluded that the studies that researched the impact of ADT on cognition in patients with prostate cancer patients all suffered from small sample sizes.

Between 47% and 69% of men on ADT declined in at least 1 cognitive area, most commonly in visual-spatial abilities and executive functioning. Some studies reported contradictory results with increased functioning in verbal memory.

It is very hard to argue that ADT is not linked to significant cognitive declines in men with prostate cancer. Surprisingly, not all clinicians believe this and so do not warn their patients about the possibility of these cognitive declines. Wake up doctors, these declines are real, must be monitored and you must warn your patients before they start ADT.

The original Sloane article was written by Nelson CJ, Lee JS, Gamboa MC, Roth AJ.

Cancer. 2008 Jul 29. Epub ahead of print.
PubMed Abstract

Joel T Nowak MA, MSW