ADT, Dementia Linked in Younger Men

Study of military men and their dependents also revealed an increased risk for depression

ANDROGEN DEPRIVATION therapy (ADT) in men aged 40 to 64 years with nonmetastatic prostate cancer (PCa) is associated with an increased risk for new-onset dementia and depression, according to investigators.

In an observational study of 9117 men aged 40 to 64 years diagnosed with localized PCa, a team led by Quoc-Dien Trinh, MD, of Brigham and Women’s Hospital in Boston, found that patients who received ADT had a significantly higher incidence of new-onset dementia and depression compared with those who did not (17.9 vs 7.5 per 1000 person-years and 30.2 vs 15.8 per 1000 person-years, respectively).

The ADT group had a 1.7- and 2.0fold increased risk for new-onset dementia and depression, respectively, compared with no-ADT, Dr Trinh and colleagues reported in European Urology Oncology. In addition, longer duration of ADT is associated with a higher risk for either outcome.

“Our results add to the evidence that the receipt of ADT is associated with depression and dementia, and emphasize the importance of neurocognitive assessment in patients undergoing ADT, especially in younger patients,” the authors wrote.

They added, “In patients with advanced disease, who are likely to remain on ADT for the rest of their lives, it is crucial to screen them for these adverse outcomes, especially in the era of promising novel agents.”

The investigators identified study patients using the TRICARE military database. TRICARE insurance covers all active and retired service members of the US armed services and their respective dependents. No patient had pre-existing diagnoses of dementia or depression. Of the 9117 men, 325 (3.6%) received ADT and 8792 (96.4%) did not. The median follow-up duration for the ADT and no-ADT groups was 9.3 and 10.0 years, respectively.

The authors pointed out that the TRICARE database does not contain detailed tumor-specific information, such as Gleason score, PSA levels, or T stage, so their analyses could not be adjusted for these factors. Another limitation was reliance on administrative claims to identify neurocognitive outcomes, as use of such claims has been shown to underestimate the true incidence of these outcomes, according to the investigators. “However, our study population consists of military service members and their dependents, which may differ from the general population,” they wrote.

Dr Trinh’s team also noted that ADT requires regular interactions with health care providers. “These regular interactions may provide more opportunity for health care providers to diagnose neurocognitive changes in patients undergoing ADT,” they wrote. “Therefore, the impact of ADT on both outcomes may be overestimated due to differential detection.” ■

ADT vs No ADT

Androgen deprivation therapy (ADT) is associated with an increased incidence of newonset dementia and depression among men aged 40 to 64 years, a study found. Shown here are the rates per 1000 person-years.

35 30 25 20 15 10 5 0

17.9%

7.5%

Dementia 30.2%

■ ADT ■ No ADT

15.8%

Depression

Source: Tully KH, et al. Risk of dementia and depression in young and middle-aged men presenting with nonmetastatic prostate cancer treated with androgen depression therapy. Eur Urol Oncol. 2021;4:66-72.

Preeclampsia Ups Future Stroke Risk

PREECLAMPSIA MAY increase a woman’s risk for a future stroke, according to new study findings.

A population-based cohort study that included 1435 women found that those with a history of preeclampsia had a nearly 3.8-fold higher risk for stroke later in life compared with women who never had preeclampsia, Adam de Havenon, MD, of the University of Utah in Salt Lake City, and colleagues reported in JAMA Network Open.

A total of 169 women had a history of preeclampsia and 231 experienced strokes during 41,422 personyears of follow-up, the investigators reported. At baseline, the women in the preeclampsia group were more likely to be younger and to be current smokers compared with women who did not experience preeclampsia. ■

Women Have Less Access to KT Waitlist

WOMEN HAVE LESS access to the kidney transplant waitlist, investigators revealed at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

According to the US Renal Data System, 19.4% of the 1,337,386 patients receiving dialysis during 2005 to 2016 were placed on the waitlist for a deceased donor kidney transplant. Across 16 of the 18 end-stage renal disease (ESRD) networks, women had less access to the waitlist compared with White men, Reem Hamoda, MPH, MD candidate, of the University of Chicago, reported. Further, Black women were more disadvantaged in waitlist access than White women in ESRD Networks 3, 6, 7, 12, 14, and 18. After the kidney allocation system was implemented in 2015, Black women and White women had a significant 26% and 18% lower likelihood of waitlisting, respectively, compared with White men. Hispanic women likewise experienced reduced access, but Asian women had increased access. The investigators estimated that 2.6% of the variation in disparities was explained by ESRD network-level variation. The model adjusted for age, clinical factors such as comorbidities, and sociodemographic factors.

“More work is needed to explain geographic variation to improve racial/ ethnic and gender equity in renal transplant access,” Hamoda’s team noted.

Future work should focus on identifying best practices in equitable ESRD networks, evaluating racial and sex-specific barriers and facilitators to transplant access, and implementing interventions to increase access, they stated. ■

Ureteral Stenting Shown to Increase UTUC Risk

ROUTINE URETERAL stenting during bladder cancer surgery to prevent or decompress obstruction should be avoided because it may give rise to upper tract urothelial carcinoma (UTUC), according to investigators.

Petros Sountoulides, MD, PhD, of Aristotle University of Thessaloniki in Greece, and colleagues performed a meta-analysis of 5 studies that included 278 ureteral stent and 131 nephrostomy placements among 3309 patients with bladder cancer treated with transurethral resection of tumor or radical cystectomy (RC). Metachronous UTUC developed in 20 (7.2%) stent cases and 3 (2.3%) nephrostomy cases.

Patients treated with ureteral stents had significant 3.5- and 3.4fold increased odds of metachronous UTUC compared with patients who had no ureteral stents or no upper urinary tract drainage, respectively, the investigators reported in The Journal of Urology.

In cases where drainage was deemed necessary, UTUC risk did not differ significantly between double-J stent and nephrostomy, even among patients with hydronephrosis. ■