Anaemia associated with androgen deprivation in patients with prostate cancer receiving combined hormone blockade
Abstract
OBJECTIVE: To describe the incidence, time to onset and extent of anaemia occurring in patients with prostate cancer receiving combined hormone blockade (CHB) and the timing and extent of recovery from anaemia in those patients where CHB was discontinued. PATIENTS AND METHODS: Patients with prostate cancer were evaluated prospectively by physical examination and laboratory tests at baseline and at routine intervals while receiving CHB. Of 142 patients who received CHB, 133 were evaluable for the assessment of anaemia; CHB was discontinued in 76 patients, of whom 64 were assessable for recovery from their anaemia. RESULTS: Haemoglobin levels declined significantly in all patients from a mean baseline of 149 g/L to means of 139 g/L, 132 g/L and 131 g/L at 1, 2 and 3 months, respectively. Haemoglobin levels continued to decline during CHB to a mean nadir of 123 g/L at a mean of 5.6 months of CHB, representing a mean absolute haemoglobin decline at nadir of 25.4 g/L. In 120 of the 133 (90%) patients, the relative decline in haemoglobin at nadir was > or = 10% and was > or = 25% in 17 (13%) others, representing a mean absolute haemoglobin decline in this subset of 42.7 g/L. Significant symptoms related to anaemia occurred in 17 patients (13%). Anaemia and symptoms in these patients were easily corrected with the subcutaneous administration of recombinant human erythropoietin. CONCLUSIONS: The anaemia associated with androgen deprivation is significant and occurs routinely in men receiving CHB. It is normochromic, normocytic, temporally-related to the initiation of androgen blockade and usually resolves after CHB is discontinued. We suggest that patients receiving CHB undergo haematological testing at baseline, 1-2 months after initiating CHB and periodically thereafter. Patients developing anaemia should be questioned about symptoms reflecting physiological compromise (e.g. angina, dyspnoea on exertion). In the absence of other causes, CHB should be suspected in the development of anaemia in patients receiving this treatment.
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Circulating hemoglobin shows a progressive fall for 6 months reaching a nadir and plateau at 12 to 16 months in six studies involving 534 men undergoing medical castration for prostate cancer.
“For example, circulating hemoglobin shows a progressive fall for 6 months reaching a nadir and plateau at 12 to 16 months in six studies involving 534 men undergoing medical castration for prostate cancer (179–184).”
From Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) · cites this paper as [180]
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“(2003) found that patients receiving androgen blockade treatment presented a decrease of at least 10% in hemoglobin in about 90% of their patients [41].”
BackgroundPathologic effects of testosterone deprivation
Sprenkle, P. C., & Fisch, H. (2007) · Current Opinion in Urology · doi:10.1097/mou.0b013e3282f0ebef · Cited by 25 · see citing works
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Treatment of prostate cancer in unfit senior adult patients
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Complications of androgen-deprivation therapy in men with prostate cancer
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“No data on toxicity, diseaserelated endpoints, or quality of life were provided [ 40 ].”
BackgroundInfluentialChang, S. L., Liao, J. C., & Shinghal, R. (2009) · The Journal of Urology · doi:10.1016/j.juro.2009.02.141 · Cited by 24 · see citing works
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Safety and tolerability of intermittent androgen deprivation therapy: A literature review
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“Erythropoietin treatment resulted in symptom improvement in several studies [14,16,17].”
BackgroundResultInfluentialRadiation Therapy Combined With Hormone Therapy for Prostate Cancer
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Hepcidin is not essential for mediating testosterone's effects on erythropoiesis
Guo, W., Schmidt, P. J., Fleming, M. D., & Bhasin, S. (2019) · Andrology · doi:10.1111/andr.12622 · Cited by 21 · see citing works
The Treatment of Hormone Refractory Prostate Cancer
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- Authors
- STRUM, S. B., McDERMED, J. E., SCHOLZ, M. C., JOHNSON, H., & TISMAN, G.
- Affiliations
- Marina Del Rey Hospital (US)
- Corresponding author
- STRUM, S.B.
- Venue
- British Journal of Urology
- Publisher
- Wiley
- Published
- 1997-06
- Volume
- 79
- Issue
- 6
- Pages
- 933-941
- ISSN
- 0007-1331 (ISSN-L)
- OpenAlex
- W2050743117
- Cited by
- 215
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 6 · 2016: 2 · 2015: 9 · 2014: 6 · 2013: 10 · 2012: 16
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- anemia, prostate cancer, androgen deprivation therapy, haemoglobin decline, normocytic normochromic anemia, recombinant human erythropoietin, hematological monitoring
- MeSH terms
- Age Factors, Aged, Anemia, Anilides, Antineoplastic Combined Chemotherapy Protocols, Flutamide, Hemoglobins, Humans, Male, Nitriles, Prospective Studies, Prostatic Neoplasms, Testosterone, Time Factors, Tosyl Compounds, Finasteride
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