Cherrier et al. BMC Cancer 2010, 10:1 http://www.biomedcentral.com/1471-2407/10/1 Results of the current study suggest that circulating androgen levels may modulate neural activity, particu- larly with regard to tasks that are spatially demanding or require spatial transformation processing. In particu- lar, declines in neural activity were evident only in the ADT group compared to baseline and were most pro- nounced for those tasks with spatial demand such as three-dimensional rotation and the recall of the spatial location of objects from the EMT. The clinical relevance of these tasks relates to everyday tasks such as con- structing or putting together furniture, household items or building structures as well as map reading and navi- gating which often require spatial or three dimensional mental transformations. Although we have demon- strated objective evidence of declines in spatial abilities in men undergoing ADT [11,20], ideally these should correspond to subjective reports of everyday task diffi- culties. We are currently, investigating the nature of subjective cognitive complaints in ADT patients. How- ever, it is not unusual for patients to demonstrate poor self or subjective appraisal of cognitive abilities such that objective and subjective measurement do not match (see for example [44-46]). This has also been observed in cancer patients (e.g. Jacobs (2007) [47]) who may be undergoing tremendous personal and health challenges. The neuroimaging results provide further convergence of evidence and a neural link with regard to our earlier observed findings of declines in spatial abilities. While these results are interesting the sample size was limited. Thus, results will need to be independently replicated with a larger sample. Nonetheless, the same decline in task related activation following ADT was evi- dent for both cognitive tasks thus lending some support to consistency despite the small sample size along with the study design which was prospective and repeated measure thus there were two scans analyzed for each subject. In addition, the study was prospective and enrolled participants prior to the start of treatment, thus establishing a clean baseline and the sample size is con- sistent with other studies involving cancer patients and neuroimaging (See McDonald et al. (2008) [48] for a review) or studies involving coordination of neuroima- ging along with treatment. An additional consideration is that the sample was highly educated (mean of 17 years). This may have had an impact on the participants’ ability to perform the cognitive tasks and may also pro- vide considerations for the generalizabiltiy of the results to the population of men with prostate cancer. However, patients were range matched to controls for age and education, which may have provided some control over differences between the groups. Page 7 of 8 Acknowledgements This study was supported in part by NIA K01AG00858, M01-RR-00037 and Department of Defense, Prostate Cancer Research Program (DAMD17-03-1- 0045)- MMC and the Department of Veterans Affairs Puget Sound Health Care System (VHAPSHCS). PRB is supported by 1KL2RR025015-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Views and opinions of, and endorsements by the author(s) do not reflect those of the USArmy or the Department of Defense. The authors wish to thank Marisa Johnson, Teresa Gambol, Jennifer Jenkins, and Jeff Stephenson for their excellent technical assistance. Author details 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; 98195; USA. 2Department of Medicine, University of Washington School of Medicine, Seattle, WA; 98195, USA. 3MIRECC VAPSHCS, 1660 S. Columbian Way Seattle WA 98108; USA. 4Department of Psychological and Brain Sciences, Ames Hall/3400 North Charles Street, Johns Hopkins University, Baltimore, MD 21218: USA. Authors’ contributions MC participated in the design & coordination of the study, collection of data, data analysis and manuscript preparation. PB participated in the data analysis and manuscript preparation. AS participated in the design of a fMRI cognitive task and data analysis and manuscript preparation. CSH participated in the design and coordination of the study, data collection and manuscript preparation. Competing interests The authors declare that they have no competing interests. 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