Some men complain that ADT effects their brain. Specifically, they report an inability to remember, an increase of general confusion and trouble focusing on immediate tasks.
My personal experience confirms these reports. While on ADT, I often found that I could not recall specifics of conversations or commitments that others claimed I made. I know that this in fact has been an issue for many years with my wife who claims I never listen, but that was prior to starting ADT (I guess that I should not be surprised about this). Once on ADT, I found that this problem generalized into all parts of my life.
I also found that it was both difficult and no longer pleasant to read. Considering I loved to read this came as a shock to me. I particularly enjoyed reading prior to going to sleep, but found that I no longer was able to follow a story line. Surprisingly, I was not even able to remember who the characters in the book were. I did develop a solution, I went to the book store and purchased an “adolescence’s boy” adventure novel which I read every night. Each night I would start at the beginning of the book and read the first four to five chapters. Each night both the story and the characters were new! I read the same beginning chapters of that book for five monthsand enjoyed it each night.
I also struggled with confusion. I was born in New York City and I have lived the passed 32 years in the city. I know the NYC subway system backwards and forwards. However, when I started ADT I often found myself becoming lost, I was unable to get from one place to the next. It was not uncommon for me to not even be able to figure out which train took me downtown and which would take me uptown. Often, I found myself in the position of asking for assistance in finding the downtown train while actually standing underneath the sign that read “Downtown”!
Tomasz Beer, Lisa Bland et al, (The J of Urology, V.175, issue 1, pp 130-135, January 2006) studied this phenomena and treated men’s confusion with Estradiol Therapy. They found that immediate and delayed verbal memory was significantly worse in patients 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 At Task, indicating slower processing speed, but did not differ significantly from healthy controls in working memory tasks. In individual repeated measures analysis, verbal memory performance improved with Estradiol therapy but did not change in the two control groups.
Their conclusions were that sex steroid loss and replacement have effects on specific cognitive processes in older men. Furthermore, estrogen has the potential to reverse the neurotoxic effects on memory performance caused by androgen deprivation.
If you do suffer with any of these symptoms and it interferes with your ability to navigate in the world you should discuss the possibility of starting Estradiol Therapy. Make sure that you and your physician evaluate the implications for the increased risks of cardiovascular problems that can be associated with the use of Estrogen.
Joel T Nowak MA, MSW
I was working as an appellate attorney in a practice limited to veterans’ appeals at the time my cancer was diagnosed. Something I had noticed, though only vaguely, in the months prior to my diagnosis was a deterioration in the quality and quantity of briefs I was handling. I had to work hard to stay focused and to express arguments clearly and succinctly and I could not undertand why the work I had been doing for years had suddenly grown so much harder to perform. RP reduced my PSA only for a few weeks. By two months post surgery my PSA had climbed to six times the value just prior to diagnosis, so I went on ADT. It is hard to say where the effect of the cancer ends and the ADT begins but the effect on my intellictual abilities, never great, has been profound. I can still do the same things, read a book or poem, draft and argument but it is much harder work and takes a lot longer than it used to. I gave up the veterans’ practice and found a line of work that was not as demanding, though I took a substantial pay cut to do it. The pay cut was better than getting fired, losing benefits and then falling under the “pre-existing condition” bus.