The findings in this article surprised me.  It seems to suggest that
the various SE's associated with ADT are, on average, only in some
rather small part, attributable to the ADT itself.  In other words, if
you compared the SE's of men with PCa who are and are not using ADT,
and matched them for various other factors, (age, co-morbidities,
cancer stage, etc.), then the level of SE's in the two groups wouldn't
too different!  The study uses a valid database (SEER) and involves a
large sample.  Huh, curious what others think...Ron

Risk of the "Androgen Deprivation Syndrome" in Men Receiving Androgen
Deprivation for Prostate Cancer

Vahakn B. Shahinian, MD, MS; Yong-Fang Kuo, PhD; Jean L. Freeman, PhD;
James S. Goodwin, MD

Arch Intern Med. 2006;166:465-471.

Background:  Androgen deprivation therapy for prostate cancer has been
associated with a spectrum of adverse effects, such as depression,
memory difficulties, and fatigue, termed the androgen deprivation
syndrome. Primary care physicians providing follow-up care for men with
prostate cancer will be faced with managing these effects. We therefore
sought to estimate the incidence of these effects and, by using a
control group, ascertain whether these effects were related to androgen
deprivation itself.

Methods:  We assessed the risk of physician diagnoses of depression,
cognitive impairment, or constitutional symptoms in Medicare data
following androgen deprivation using a sample of 50 613 men with
incident prostate cancer and 50 476 men without cancer, from 1992
through 1997, in the linked Surveillance, Epidemiology, and End
Results-Medicare database. Cox proportional hazards regression was
used to adjust for confounding variables.

Results:  Of men surviving at least 5 years after diagnosis, 31.3% of
those receiving androgen deprivation developed at least 1 depressive,
cognitive, or constitutional diagnosis compared with 23.7% in those who
did not (P<.001). After adjustment for variables such as comorbidity,
tumor characteristics, and age, the risks associated with androgen
deprivation were substantially reduced or abolished: relative risk (RR)
for depression diagnosis, 1.08 (95% confidence interval [CI],
1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and
RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22).

Conclusion:  Depressive, cognitive, and constitutional disorders occur
more commonly in patients receiving androgen deprivation, but this
appears to be primarily because patients receiving androgen deprivation
are older and have more comorbid conditions and more advanced cancers.