Prostate cancer patients treated with second-generation antiandrogens may have an increased risk of falls, fatigue, and cognitive toxicity, according to a meta-analysis published in JAMA Oncology.

The meta-analysis included data from 12 randomized controlled trials including a total of 13,524 patients.

There were 4 studies that included data on cognitive toxicity. The data suggested that patients who received second-generation antiandrogens had more than twice the risk of cognitive toxic effects as control individuals (risk ratio [RR], 2.10; 95% CI, 1.30-3.38; P =.002).

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Six studies included data on falls. The use of second-generation antiandrogens was associated with an 87% increase in the risk of falls (RR, 1.87; 95% CI, 1.27-2.75; P =.001) and a 72% increase in the risk of grade 3 or higher falls (RR, 1.72; 95% CI, 1.01-2.94; P =.05).

All 12 studies included data on fatigue. There was a 34% increase in the risk of fatigue among patients receiving second-generation antiandrogens (RR, 1.34; 95% CI, 1.16-1.54; P <.001).

“The findings of this study suggest the need to prevent, identify, and intervene on cognitive and functional toxic effects in patients receiving second-generation AAs [antiandrogens] for prostate cancer,” the researchers wrote.


Nowakowska MK, Ortega RM, Wehner MR, Nead KT. Association of second-generation antiandrogens with cognitive and functional toxic effects in randomized clinical trials: A systematic review and meta-analysis. Published online May 25, 2023. doi:10.1001/jamaoncol.2023.0998

This article originally appeared on Cancer Therapy Advisor