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TOPLINE:

Patients with prostate cancer receiving hormone therapy reported greater perceived cognitive difficulties, but cognitive tests found "no conclusive evidence of a decline," a new meta-analysis found.

METHODOLOGY:

• Newer hormone therapy options and androgen‐deprivation therapy in prostate cancer can come with side effects to the central nervous system, such as confusion or other cognitive issues. However, it's not clear whether hormonal and cognitive changes in these patients are due to the normal aging process or the cancer treatments.
• The current analysis evaluated the impact of these therapies on objective cognition (using cognitive tests) and subjective cognition (using questionnaires) in patients with prostate cancer.
• In the systematic review, the researchers included 20 studies with 1440 patients receiving androgen‐deprivation therapy and new‐generation hormone therapy, and in the meta-analysis, the researchers assessed 15 studies with 1093 patients.
• The researchers compared objective and subjective cognitive scores at baseline and 6-month follow-up after initiating therapy. Cognitive categories included processing speed and attention, working, visual, and verbal memory, visuospatial abilities, and executive function.
• Between 20% and 50% already had impaired objective cognitive function at baseline.

TAKEAWAY:

• In the meta-analysis, the researchers found a significant decrease in subjective cognitive function among those receiving hormone therapy (effect size, −0.44; P = .03).
• When looking at the objective changes, the researchers reported an increase in performance between baseline and follow-up for visual memory (effect size, 0.11; P = .02) and executive functions (effect size, 0.18; P = .05) among patients receiving hormone therapy.
• The differences in objective processing speed and attention, working memory, verbal memory, and visuospatial abilities, however, were not statistically significant.
• When comparing objective cognitive function between patients receiving hormone therapy and controls (those with prostate cancer not on hormone therapy or healthy individuals), the authors also found no significant differences in objective cognitive domains.

IN PRACTICE:

"Our analyses showed an increase in perceived cognitive impairment scores during treatment" but "did not provide conclusive evidence of a decline in objective cognition" in patients with prostate cancer, the authors said.

SOURCE:

This meta-analysis, led by Antoine Boué from Normandie University, Caen, France, was published in Cancer.

LIMITATIONS:

The key limitation was combining effect sizes from a heterogeneous group of studies. Studies also used different analytical methods to define cognitive change. Long-term cognitive effects from hormone therapy were not evaluated.

DISCLOSURES:

This work was supported by the French National Cancer Institute. One author received travel support and personal, consulting, and lecture fees outside this work.