Prostate Cancer Treatment Was Not Associated With Cognitive Decline in Older Men

Geriatric patients with prostate cancer did not experience a decline in cognative function regardless of treatment.

Older men with prostate cancer did not experience a significant cognitive decline in attention, executive function, and global cognition, regardless of the therapy that they received, according to a study posted in JAMA Network Open.

A cognitive decline of 1.5 standard deviations (SDs) or more occurred in 0% to 6.5% of patients (n = 3/46; 6.5%; 95% CI, 2.2%-17.5%) within each cognitive function among those receiving chemotherapy. However, in each group, 90% to 100% of patients had no clinically important change from baseline. No patients within the abiraterone group (0%; 95% CI, 0%-12.1%) experienced a decline of 1.5 SDs for the Trails A, Trails B, or Montreal Cognitive Assessment (MoCA). However, those in the radium 223 group had more patients with worsening scores by at least 1.5 SDs; however, investigators did not find this to be statistically significant. Notably, those who were treated with enzalutamide had the numerically largest declines vs abiraterone, although investigators noted that the differences appeared to be small and clinically unimportant.

Investigators enrolled 155 men, 51 of whom had been treated with docetaxel, 29 men were treated with abiraterone, 54 men were treated with enzalutamide, and 21 men were treated with radium 223. At baseline, all cognitive functions were similar between groups. Characteristics were similar among those who completed the study and those who did not, however, those who did not complete the study had worse Trails B scores at baseline.

In the univariate linear regression, increasing of age was associated with greater decline in Trail A score (over 85 years vs 65-74 years, β = 8.84; P = .03). However, the same could not be said for the other 2 cognitive tests (Trails B score for patients older than 85 years vs 65-74 years, β = 6.06; total MoCA score for over 85 years vs 65-74 years, β = 0.35).

Patients’ educational attainment, defined as some postsecondary school vs high school or less, (Trails A, β = -0.79; Trails B, β = -7.47, and MoCA, β = -0.04), frailty (Trails A, β = 2.49; Trails B, β = -7.47; and MoCA, β = -0.36), instrumental activities of daily living (Trails A, b = 0.45; Trails B, b = 7.19; and MoCA, b = -0.07), and performance status (Trails A, β = 2.42; Trails B, β = 15.62; and MoCA, β = -1.48) were all not associated with cognitive decline.

With the exception of baseline test scores (Trails A, β = -0.27; Trails B, β = -0.32; and MoCA, β = -0.31), no other variable was significantly associated with cognitive decline. The dosing of chemotherapy was also not associated with cognitive decline.

“These analyses revealed that most patients in each treatment group had stable cognitive function between the start and end of treatment, and no patient declined by at least 1.5 SDs on 2 or more cognitive measures. The study did not identify any consistent association between cognitive decline and advanced prostate cancer,” concluded investigators. 


Alibhai SMH, Breunis H, Feng G, et al. Association of chemotherapy, enzalutamide, abiraterone, and radium 223 with cognitive function in older men with metastatic castration-resistant prostate cancer. JAMA Netw Open. 2021;4(7):e2114694. doi:10.1001/jamanetworkopen.2021.14694

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