Meta-Analysis of Androgen Deprivation Therapy's Impact on Cognitive Disorders in Prostate Cancer Patients: Evidence From Korean Real-World Data

OBJECTIVES: This study aims to quantitively synthesize the safety of androgen deprivation therapy (ADT) to increase the risk of dementia or Parkinson’s disease in patients with prostate cancer in a Korean real-world setting through a systematic review and meta-analysis.

METHODS: A systematic literature review was conducted in June 2023 using PubMed and Google Scholar databases, supplemented by manual searches. Five studies meeting predefined inclusion and exclusion criteria were included. Data on the source, study period, and analysis methods were extracted and presented in a table format. Meta-analysis was performed for the effect of ADT use using Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) with the fixed and random effects models. Outcomes were defined as overall dementia, Alzheimer’s disease, vascular disease and Parkinson’s disease. Forest plots were generated for each outcome.

RESULTS: All five included studies utilized data from the Korean national claims databases covering the period from 2008 to 2017. As a result of the random effect model, ADT use was associated with a 1.13-fold increase in the risk of Alzheimer's disease (HR=1.13, 95% CI: 1.01-1.26, p=0.03). Conversely, ADT did not statistically significant elevate the risk of overall dementia by an 1.06-fold increase (95% CI: 0.99-1.12, p=0.09) and vascular dementia (HR=1.00, 95% CI: 0.84-1.20, p=0.974). The risk of Parkinson's disease was found to increase by approximately 1.12 times, but this was also not statistically significant (HR=1.12, 95% CI: 0.93-1.34, p=0.23).

CONCLUSIONS: This systematic review and meta-analysis indicate that the use of ADT in prostate cancer patients may increase the risk of developing Alzheimer’s disease but does not significantly affect the risks of overall dementia, vascular dementia, or Parkinson’s disease. Therefore, monitoring for Alzheimer’s disease is recommended for patients undergoing ADT as part of prostate cancer treatment.