Current neuropharmacology · 2026
Association of Androgen Deprivation Therapy with Cerebral Small Vessel Disease Burden in Prostate Cancer.
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Zeng Longhai, Bi Rentang, Yang Zijun, Liu Qian, Qiu Yanmei, Wei Yanhao, Peng Haokun, Xiong Wenbin, Hu Bo, Li Ya'nan
Аннотация
INTRODUCTION: Androgen Deprivation Therapy (ADT) is essential for advanced Prostate Cancer (PCa) but may increase cardiovascular and cerebrovascular risks. Its adverse effects on cerebral small vessels remain unclear. Leukoaraiosis (LA) and Lacunar Infarction (LI) are neuroimaging markers of Cerebral Small Vessel Disease (CSVD) associated with cognitive decline and stroke.
METHODS: This retrospective analysis used data from the multi-center SMART cohort (13 hospitals, 2014-2025) to examine associations between ADT exposure and CSVD burden using multivariate logistic regression, with stratified analyses by treatment duration and modality. Mediation analysis assessed the statistical role of systemic inflammation.
RESULTS: PCa patients receiving ADT (n=210) had a significantly higher risk of LA (adjusted OR=1.59, 95% CI: 1.15-2.20) compared to non-ADT users (n=1,181), but no significant increase in LI risk was observed. In the statistical mediation analysis, the Systemic Inflammation Response Index (SIRI) accounted for 27.21% of the observed association between ADT and LA. A duration-dependent association was evident, with significantly elevated LA risks in patients receiving medium-long term (12-24 months) and long-term (>24 months) ADT.
DISCUSSION: These findings suggest that ADT is associated with increased cerebral small vessel injury, particularly LA. The duration-dependent association and the statistical association involving systemic inflammation are consistent with a potential pathway linking ADT to cerebrovascular damage, but causality cannot be inferred. Monitoring cerebrovascular health and inflammatory markers in patients on prolonged ADT may aid risk stratification.
CONCLUSION: In this retrospective analysis of PCa patients without prior cardiovascular or cerebrovascular disease, ADT was associated with an increased burden of early LA in a duration-dependent manner, with systemic inflammation statistically accounting for part of this association.
METHODS: This retrospective analysis used data from the multi-center SMART cohort (13 hospitals, 2014-2025) to examine associations between ADT exposure and CSVD burden using multivariate logistic regression, with stratified analyses by treatment duration and modality. Mediation analysis assessed the statistical role of systemic inflammation.
RESULTS: PCa patients receiving ADT (n=210) had a significantly higher risk of LA (adjusted OR=1.59, 95% CI: 1.15-2.20) compared to non-ADT users (n=1,181), but no significant increase in LI risk was observed. In the statistical mediation analysis, the Systemic Inflammation Response Index (SIRI) accounted for 27.21% of the observed association between ADT and LA. A duration-dependent association was evident, with significantly elevated LA risks in patients receiving medium-long term (12-24 months) and long-term (>24 months) ADT.
DISCUSSION: These findings suggest that ADT is associated with increased cerebral small vessel injury, particularly LA. The duration-dependent association and the statistical association involving systemic inflammation are consistent with a potential pathway linking ADT to cerebrovascular damage, but causality cannot be inferred. Monitoring cerebrovascular health and inflammatory markers in patients on prolonged ADT may aid risk stratification.
CONCLUSION: In this retrospective analysis of PCa patients without prior cardiovascular or cerebrovascular disease, ADT was associated with an increased burden of early LA in a duration-dependent manner, with systemic inflammation statistically accounting for part of this association.