Cognitive and Psychological Impacts of Different Treatment Options for Prostate Cancer: A Critical Analysis

Abstract

<b><i>Objectives: </i></b>Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options. <b><i>Methods: </i></b>Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed. <b><i>Results: </i></b>A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent. <b><i>Conclusion: </i></b>Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short- and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties.

Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients’ Real-World Insights for Optimizing Outcomes

“…Unfortunately, there is little PCa-specific clinical data on the physical, emotional, and social impact of treatment-related CI on QoL in patients with PCa-TRCI, which is a gap that should be brought to the forefront of unmet healthcare needs in patients with PCa. Compounding this gap is the indication that HCPs may view QoL in patients with PCa as an extraneous or “soft” patient need and prioritize survival over QoL, which is a barrier to understanding the patient’s QoL experience [ 4 , 22 , 42 ]. While survival is of paramount importance, concerns for survival must also be balanced with QoL concerns.…”

“…This increase in survival, while a positive change overall, has created a host of new healthcare concerns and highlighted knowledge gaps regarding the long-term effects of treatment [ 3 – 5 ]. One major concern is the growing awareness and increasing prevalence of cognitive impairment (CI) that is frequently reported in patients with PCa [ 4 , 6 – 9 ].…”

Treatment of intermediate-risk prostate cancer with active surveillance in the routine care—Long-term outcomes of a prospective noninterventional study (HAROW)

“…This becomes evident when examining the reasons for discontinuation: 36% of patients switched to invasive treatment upon their own decision or physician's advice in the absence of any signs of progression. Although most studies and meta-analyses support the assumption that AS is not a threat to the psychological well-being of PCa patients, [25] some patients report having the perception of risking their life by submitting to AS alone. [26,27] In addition, patients significantly overestimate the risk of PCa mortality, regardless of the treatment option chosen.…”

Prostate-Specific Antigen and Testosterone Levels as Biochemical Indicators of Cognitive Function in Prostate Cancer Survivors and the Role of Diabetes

“…The relationship between cognitive function and PSA could be related to the treatment; some studies have reported that cognitive function in PC depends on the type of treatment [30,31]. The role of ADT, which is often used as an adjuvant treatment, is emphasized.…”