Vascular health and cognition parameters in patients receiving antiandrogen therapy

Alek Popović¹, Ante Reljić¹, Irena Martinić¹ Popović², Arijana Lovrenčić-Huzjan², Darja Šodec Šimićević², Vanja Bašic-Kes², Vesna Šerić²,

University Department of Urology¹, University Department of Neurology²„Sestre milosrdnice“ University Hospital Center, Zagreb, Croatia

Introduction and aim: It is well known that both testosterone levels and cognitive abilities decline with age. Low serum testosterone levels is linked to increased vascular risk and changes of vascular parameters are associted with cognitive decline. Patients with locally advanced prostate cancer (PC), which is hormone sensitive/dependent, are routinely treated using antiandrogene therapy (AAT), until castration testosterone levels are reached. Our aim was to assess the associations between testosterone levels, cognitive abilities and vascular physiology parameters in patients receiving AAT.

Methods: Our study included 34 consecutive PC patients receiving AAT for 6-10 months (mean age 72,7 ± 5,5 years) and 35 healthy male controls, matched for age and vascular risk factors. In all subjects serum testosterone levels were analyzed and neurosonological assessment of the carotid arteries, including intima-media thickness (IMT), augmentation index (AI) and beta-stiffness index (BSI) measurements, was performed. Cognitive assessment was done using MMSE and Montreal Cognitive Assessment (MoCA).

Results: PC patients had significantly lower testosterone levels than controls (p<0,01). MMSE scores were normal in all subjects. When assessed using MoCA, 88% of PC patients had impaired cognition (≤26 points) vs. 63% of controls. In patients, significanly lower scores on MoCA subtests of verbal recall, attention and visuospatial abilities were observed (p<0,05). BSI values were significantly higher in PC patients (10,9±1,4) than in controls (8,9±2,3); p<0,05. IMT and AI values did not differ significantly between two groups.

Conclusions: Our data indicate that artificially lowering testosterone levels in patients with locally advanced PC may adversely affect some markers of vascular physiolgy and also further impaire cognitive abilities.