This approach has allowed for characterization of the biological, psychological, and quality of life effects of ADT and which effects are reversible or attenuated when the testosterone levels increase during the 'off treatment' period. ![]() Intermittent ADT is a treatment strategy that cycles androgen withdrawal with an "off treatment" period allowing the testosterone levels to return to eugonadal levels. Twelve prostate cancer patients with rising PSA (biochemical relapse) following primary therapy (radiation, brachytherapy or prostatectomy) in which intermittent androgen suppression (ADT) therapy is indicated were eligible and gave informed consent to participate. The sample is a convenience sample comprised of those participants who were willing to undergo neuroimaging procedures in addition to the cognitive assessment procedures in the larger study. Participants were a subset of participants from a larger study examining cognitive and mood changes in ADT who agreed to the additional neuroimaging procedures (See for details). We hypothesized that men undergoing ADT would show reduced activation in the task-related parietal region during spatial reasoning and spatial memory tasks compared to baseline and to healthy controls. ![]() The aim of the present study was to assess changes in neural activation in response to androgen deprivation using functional magnetic resonance imaging (fMRI). Spatial reasoning and spatial memory were specifically chosen to examine the effects of ADT on brain function because task-related brain activation has been clearly identified, particularly in regions of the parietal cortex along with evidence of hormone influences on these brain regions. Given these cognitive and medical side effects of ADT understanding the immediate and long-term consequence of treatment is essential.īased on findings from our previous study demonstrating a decline in spatial reasoning abilities in healthy men undergoing ADT, the aim of this study was to examine if neural activation changes were evident in response to androgen deprivation while performing spatial reasoning and spatial memory tasks using functional magnetic resonance imaging (fMRI). Psychiatric changes can include depression and anxiety and cognitive problems can include impairments in verbal memory, spatial reasoning and attention. A recent population based study showed that ADT was associated with an increased risk of diabetes, myocardial infarction, and hypertension. Physiological consequences of androgen deprivation include obesity, anemia, loss of bone mineral density, muscle atrophy, gynecomastia and mood changes. In contrast to those with metastatic disease the latter patients often have no disease related symptoms and may live for many years. in combination with radiation therapy) or for the 22% of patients who fail primary therapy and have a rising PSA without evidence of metastases. While androgen deprivation therapy (ADT) used to be reserved for those with metastatic disease and resulted in a median survival of 2-5 years, ADT is now commonly prescribed in the setting of localized disease (e.g. men with over 218,000 newly diagnosed cases each year estimated per year. Prostate cancer is the most common form of non-skin cancer diagnosed in U.S. Conclusionsįindings, while preliminary, suggest that ADT reduces task-related neural activation in brain regions that are involved in mental rotation and accurate recall of spatial information. Reduction in activation in right parietal-occipital regions from baseline was observed during recall of the spatial location of objects and mental rotation. ResultsĪDT patients showed reduced, task-related BOLD-fMRI activation during treatment that was not observed in control subjects. Seven healthy control patients, underwent neuroimaging at the same time intervals. ![]() Functional magnetic resonance imaging (fMRI) of the brain during three visuospatial tasks was performed at baseline prior to treatment and after nine months of ADT in five subjects. In this study, hormone naïve patients without evidence of metastases with a rising PSA were treated with nine months of ADT. However, men undergoing ADT may experience physical side effects, changes in quality of life and sometimes psychiatric and cognitive side effects. A common treatment option for men with prostate cancer is androgen deprivation therapy (ADT).
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