Prostate Cancer Drug May Help Preserve Cognitive Function in Advanced Disease

Advanced prostate cancer treatments can affect cognitive function, and new findings suggest that one commonly used medication may have a smaller impact on mental performance than another. A phase II clinical trial presented at the American Society of Clinical Oncology (ASCO) meeting compared two androgen receptor pathway inhibitors: darolutamide and enzalutamide. Researchers found that patients treated with darolutamide experienced significantly less cognitive decline over 24 weeks than those receiving enzalutamide. Cognitive changes were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), which measures abilities such as memory, attention, executive function, and working memory.

The median decline in the most affected cognitive domain was -15.8% with darolutamide compared with -36.1% with enzalutamide. Researchers believe this difference may be linked to darolutamide’s limited ability to cross the blood-brain barrier, reducing its impact on brain androgen receptors. Although cognitive changes were measurable, investigators emphasized that no patients developed dementia during the study, and the findings should not be interpreted as evidence of a clinical cognitive disorder.

Experts noted that cognitive impairment can significantly affect quality of life, causing issues such as memory problems, impaired daily functioning, and increased fall risk. Among participants, many patients switched from enzalutamide to darolutamide due to cognitive concerns, while none switched in the opposite direction. These results suggest that darolutamide may provide an option for preserving cognitive health in men with advanced prostate cancer while maintaining treatment effectiveness.

Bassett, M. (2026, May 22). Prostate cancer drug linked to lower risk of cognitive decline: Darolutamide offers “an option for preserving cognitive health” in advanced disease, expert says. MedPage Today. MedPage Today