medwireNews: Common treatments for metastatic castration-resistant prostate cancer (mCRPC) are not associated with significant cognitive decline in older men, research suggests.
Shabbir Alibhai (Toronto General Hospital, Ontario, Canada) and co-investigators found that more than 90% of 155 men aged 65 years and older treated at four academic centers in Ontario had improved, stable, or only slightly reduced cognition after 6 months of radium-223 dichloride or docetaxel, or after approximately 11 months of abiraterone acetate or enzalutamide, with minimal differences between each treatment group.
The researchers measured global cognition using the Montreal Cognitive Assessment (MoCA), attention using the Trail Making Test (Trails) part A, and executive function using Trails part B.
They report in JAMA Network Open that no patient given any of the drugs had a clinically significant cognitive decline, defined as a reduction of 1.5 standard deviations (SDs) or more on at least two of the three cognitive measures.
Assessing cognition for each agent individually, Alibhai and team found that none of the 29 patients who received abiraterone experienced a decline of 1.5 SDs or more after treatment on any of the measures.
There were also no declines of this level on the Trails A and Trails B tests among the 54 participants who received enzalutamide, and just one (1.9%) patient of the 52 assessed had a 1.5 SD or greater reduction on the MoCA test.
In the radium-223 group, the were no significant declines in the Trails A test, but one (4.8%) of the 21 patients who took the Trails B test and one (5.0%) of the 20 who took the MoCA test experienced a decline of 1.5 SDs or greater.
The numbers were slightly higher, but not significantly so, among the individuals who received docetaxel, at three (6.5%) of 46 for both Trails A and Trails B, and two (4.3%) of 47 for MoCA.
On multivariable analysis, only baseline test score was significantly associated with cognitive decline.
Alibhai and co-authors conclude: “These findings suggest that most older men do not experience significant cognitive decline in attention, executive function, and global cognition while undergoing treatment for advanced prostate cancer regardless of the treatment used.”
However, they add that some methodologic limitations mean that “future trials using a more thorough neuropsychological assessment, self-reported measures, and a larger sample with multiple times are warranted.”
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