Can treatments for prostate cancer cause dementia?

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Last updated: May 20, 2025 • View editorial policy

From the Guidelines

Prostate cancer treatments, specifically androgen deprivation therapy (ADT), have been linked to an increased risk of cognitive impairment and dementia, as reported in a recent study published in the BMJ in 2023 1. The association between ADT and cognitive decline is thought to be related to the reduction in testosterone levels, which can affect brain function over time. Key points to consider include:

  • The risk of cognitive impairment appears to be higher with longer treatment duration, typically after several months of continuous therapy, with some studies showing a significant decline in cognitive function scores in patients treated with enzalutamide compared to those receiving abiraterone acetate plus prednisone 1.
  • The absolute risk increase is relatively modest, with studies suggesting approximately a higher risk of developing cognitive impairment in men on ADT compared to those not receiving this treatment, although the exact incidence rates are difficult to quantify due to limitations in cognitive evaluation tools used in many randomized trials 1.
  • Patients considering ADT should discuss this potential side effect with their healthcare provider, weighing it against the benefits of cancer control, and alternative treatment approaches or intermittent ADT schedules might be considered for patients with existing cognitive concerns or those at high risk for dementia. The use of ADT medications like enzalutamide and abiraterone acetate plus prednisone should be carefully evaluated, taking into account the potential risks and benefits, as suggested by the recent systematic reviews of studies evaluating cognitive impairment in men treated with ADT for prostate cancer 1.

From the Research

Prostate Cancer Treatments and Dementia Risk

  • There is evidence to suggest that certain prostate cancer treatments, specifically androgen deprivation therapy (ADT), may be associated with an increased risk of dementia 2, 3, 4, 5, 6.
  • Studies have shown that ADT may increase the risk of dementia, including Alzheimer's disease and other types of dementia 2, 3, 5.
  • The risk of dementia associated with ADT may be higher for men who receive longer durations of treatment, with one study finding an increased risk for men who received ADT for more than 12 months 3, 5.
  • The mechanisms by which ADT may increase the risk of dementia are not fully understood, but may involve changes in hormone levels and their effects on the brain 4.
  • The association between ADT and dementia risk has been observed in several studies, including a systematic review and meta-analysis of 14 studies 3 and a cohort study of over 9,000 men with prostate cancer 5.
  • The increased risk of dementia associated with ADT should be carefully considered and discussed with patients who are being considered for this treatment 6.

Types of Dementia Associated with ADT

  • Alzheimer's disease: some studies have found an increased risk of Alzheimer's disease associated with ADT 2, 3, 5.
  • Non-Alzheimer's dementia: other studies have found an increased risk of non-Alzheimer's dementia, including vascular dementia and other types of dementia 4, 5.
  • All-cause dementia: the risk of all-cause dementia, including both Alzheimer's and non-Alzheimer's dementia, has also been found to be increased in men who receive ADT 2, 3, 5.

Clinical Implications

  • The potential for neurocognitive deficits secondary to ADT should be discussed with patients and evaluated prospectively 2.
  • The benefits and risks of ADT should be carefully considered and discussed with patients who are being considered for this treatment 6.
  • Further research is needed to fully understand the association between ADT and dementia risk, and to develop strategies for mitigating this risk in men who receive ADT for prostate cancer 3, 5.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.