| Objective To observe and assess the cognitive changes in older men undergoing complete androgen blockade for non-metastatic prostate cancer.Methods A prospective study was conducted among 40 patients years with nonmetastatic prostate cancer undergoing complete androgen blockade and 39 controls with non-metastatic prostate cancer undergoing radical prostatectomy.Montreal cognitive assessment(Mo CA)were performed in all subjects at the beginning and 6,12 months after the study,and the differences were analyzed statistically.There was no statistically significant difference between CAB group and control group(P>0.05)in the overall scores of Mo CA at the onset of the study.Results There were no significant differences between two groups in the baseline of testosterone[(17.09 ± 3.46)nmol/L vs.(16.89 ± 3.27)nmol/L,P>0.05]and estradiol[(107.97±32.34)pmol/L vs.(107.48±32.62)pmol/L,P>0.05].Six months later,total Mo CA scores and the scores of memories,visuospatial and executive function,attention in the items of Mo CA and testosterone between CAB group and control group were(26.45±1.02 vs.27.89±0.78,P<0.001),(4.21±0.72 vs.4.68±0.58,P=0.002),(4.19±0.62 vs.4.73±0.48,P<0.001),(4.87±0.56 vs.5.42±0.75,P<0.001)and[(0.27± 0.10)nmol/L vs.(12.17 ± 2.73)nmol/L,P<0.001)],and there were significant differences between two groups.There were no significant differences between CAB group and control group in estradiol [(112.27 ± 45.29)pmol/L vs.(109.87 ± 41.58)pmol/L,P=0.807] and the items of Mo CA score,including language(2.84 ± 0.40 vs.2.79±0.43,P=0.594),naming(2.87±0.35 vs.2.72±0.41,P=0.084),orientation(5.86±0.36 vs.5.67±0.42,P=0.134)and abstract thinking(1.90±0.21 vs.1.89±0.27,P=0.852).Twelve months later,the scores of total Mo CA scores and the scores of memories,visuospatial and executive function,attention in the items of Mo CA and testosterone between CAB group and control group were(26.31±0.99 vs.27.89±0.75,P<0.001),(3.87±0.68 vs.4.69±0.54,P<0.001),(4.21±0.60 vs.4.76±0.43,P<0.001),(5.04 ± 0.69 vs.5.51 ± 0.60,P=0.002)and[(0.30 ± 0.08)nmol/L vs.(12.32 ± 3.28)nmol/L,P<0.001)],and there were significant differences between two groups.There were no significant differences between CAB group and control group in estradiol[(111.86 ± 45.27)pmol/L vs.(108.99 ± 38.57)pmol/L,P=0.763] and the items of Mo CA score,including language(2.85±0.38 vs.2.78±0.41,P=0.434),naming(2.90±0.32 vs.2.81±0.34,P=0.229),orientation(5.67±0.38 vs.5.57±0.52,P=0.331)and abstract thinking(1.94±0.32 vs.1.85±0.27,P=0.181).In CAB patients,the Mo CA score was positively correlated with serum testosterone level 6(r=0.235,P<0.05)and 12(r=0.221,P<0.05)months later.The prevalence of cognitive impairment in CAB(8/40,21%)was higher than the control group(1/39,2.56%),and there were significant differences(P<0.05).Conclusions Non-metastatic prostate cancer undergoing complete androgen blockade have serious cognitive dysfunction,which is correlated with serum testosterone decrease.Visuospatial and executive function,memories,attention may be predictors of cognitive dysfunction. |
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