Assessment and Management of Cognitive Function in Patients with Prostate Cancer Treated with Second-Generation Androgen Receptor Pathway Inhibitors

Jeffrey S. Wefel, Charles J. Ryan, Julie Van, James C. Jackson, Alicia K. Morgans

Research output: Contribution to journalReview articlepeer-review


Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.

Original languageEnglish (US)
Pages (from-to)419-449
Number of pages31
JournalCNS Drugs
Issue number5
StatePublished - May 2022

Bibliographical note

Funding Information:
JSW has acted as a consultant for Angiochem, Bayer, Juno, Novocure, Vanquish Oncology, and Magnolia Tejas, and has been an advisory board member for AbbVie, Bayer, Blueprint Medicines, and Magnolia Neurosciences. CJR has received honoraria from Janssen, Bayer, and Sanofi Aventis. JV and JJ declare no conflicts of interest. AKM has received honoraria from AstraZeneca, Astellas, Bayer, Clovis, Dedreon, Myovant, Pfizer, Novartis, Blue Earth, Janssen, Sanofi, Genentech, and Seattle Genetics, and has received research support from Bayer, Astellas, and Seattle Genetics.

Publisher Copyright:
© 2022, The Author(s).

PubMed: MeSH publication types

  • Journal Article
  • Review
  • Research Support, Non-U.S. Gov't


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