When I was on an active hormone blockade (ADT2) I suffered extensively from many of the usually reported morbidity issues (negative side effects). One of the side effects I dealt with was significant cognitive impairment.

I live in New York City, was born in the city and have spent most of my life in the city. One of the main means of transportation around the city is the subway. It is an under statement to say that I am both comfortable with and knowledgeable about the subway system. During my ADT “on time” period, on countless occasions, I found myself sitting on the train not only forgetting where I was going and how to get there, but I often could not remember why I was going to where ever it was! Again and again, I had to leave the train, walk up to the street and then call my wife to describe what I saw so she could tell me where I was, where I was trying to go and why I was going there. All I can say is that I am appreciative of auto dial on cell phones; otherwise, I could never have remembered her phone number.

Then there are the countless times I missed turns in my car, got confused about conversations I was in the middle of and generally became stupid.

Prior to ADT, I was a “reader.” During treatment I no longer was able to remember what I read, which character was who and what the prior two paragraphs said! My favorite reading time as just before bed, but I often could not remember what I had read the prior evening. I did eventually develop a solution; I went to the bookstore and bought for $5.99 an adolescent, boy’s adventure novel about pirates and wooden sailing ships. Every night I crawled into bed, opened the novel at the first chapter and read between two and three chapters. Each night the same first three chapters were always new, refreshing and exciting. I did tell my wife that that $5.99 was the best I ever spent because of the pleasure it gave me over such a long period.

A recent study looked into the data that suggests that treatment with luteinizing hormone-releasing hormone (LHRH) agonists (ADT) may be associated with reduced cognitive functioning. The study compare rates of clinically significant cognitive impairment in men on ADT with LHRH drugs to a control sample of healthy men without cancer.

The sample was small with only 48 men receiving LHRH agonist therapy for prostate cancer and 48 men with no history of cancer matched to patients on age and education. Participants were administered a battery of neuropsychological tests assessing the domains of verbal memory, verbal fluency, visuospatial memory, visuospatial abilities, and executive function. Clinically significant impairment on individual tests was defined as -1.5 SD below the normative mean; overall impairment was defined as impaired performance on two or more tests.

The two subject groups did not differ from comparison subjects in age, ethnicity, race, education, or annual household income (p’s > 0.05). No statistically significant differences in test means were found. Nevertheless, patients displayed greater overall impairment in cognitive functioning than comparison subjects (42% of patients versus 19% of comparison subjects, p < 0.05). Among patients, prior prostatectomy was associated with impaired immediate and delayed verbal memory (p's < 0.05).The finding from this study clearly suggests that LHRH agonists and surgery for prostate cancer are associated with clinically significant impairment in cognitive functioning. Longitudinal studies are needed to examine changes in cognitive impairment before and after surgical and hormonal treatment for prostate cancer. Patients undergoing LHRH agonist therapy should be monitored for cognitive changes while on treatment.Well, my experience certainly reconfirmed their findings. So, remember, the next time you see a bumbling man on the subway take compassion on him and help him to find his way. He just might be a brother in this fight against advanced prostate cancer.Reference: Support Care Cancer. 2009 Apr 3. Epub ahead of print.
doi: 10.1007/s00520-009-0625-3; Jim HS, Small BJ, Patterson S, Salup R, Jacobsen PB

PubMed Abstract

Joel T Nowak MA, MSW