Development of anemia and recovery in prostate cancer patients treated with combined androgen blockade and radiotherapy

Abstract

BACKGROUND The objective of this study was to document previously unreported anemia in prostate cancer patients treated with neoadjuvant combined androgen blockade (CAB) and pelvic radiotherapy (XRT). METHODS Four institutions treated 141 patients (mean age ± SD, 70.9 ± 6.5 years) with zoladex 3.6 mg injection subcutaneous depot monthly and flutamide 250 mg orally three times per day for 2 months (CAB), followed by zoladex and flutamide with concurrent XRT (65–70 Gy) for 7–8 weeks. RESULTS After the XRT, the patients were randomized to receive no further treatment (Z− group, 71 patients) or zoladex alone (Z+ group, 70 patients) for 2 years. Hemoglobin (Hb) levels decreased ≥1 g/dl (mean ± SE, 2.1 ± 0.1 g/dl) in 98/131 patients: (75%) after 2 months of CAB, and ≥2 g/dl (3.1 ± 0.1 g/dl; range, 0.1–6.8 g/dl) in 106/131 patients (81%) after an additional 2 months of CAB with concurrent XRT. The decrease in Hb levels paralleled the decrease in testosterone levels. No evidence of blood loss or hemolysis was found. CONCLUSIONS There was no association between incidence or rate of Hb‐decrease and race, age, or pretreatment prostate‐specific antigen (PSA) levels. However, the recovery from anemia after completion of CAB in African‐Americans was slower than in Whites in the Z+ group (P < 0.04). Whereas grade 1 hematologic toxicity may occur in <5% of the patients with zoladex alone, and ∼6% with flutamide alone, in our study 81% showed mild to pronounced anemia. Since anemia has not been observed after treatment with XRT alone or XRT followed by zoladex, we conclude that the anemia was due to CAB. Recognition of this side effect should avoid unnecessary diagnostic evaluations. © 1996 Wiley‐Liss, Inc.

Andropause: Symptom Management for Prostate Cancer Patients Treated With Hormonal Ablation

“…Asbell et al reported on a multicenter study that demonstrated the development of anemia in 141 patients undergoing CAB 2 months prior to pelvic radiotherapy. Their conclusion was that the anemia was attributable to CAB therapy, as the drop in hemoglobin was much more pronounced than that which is usually seen with radiation therapy to the prostate [89].…”

Erythropoietin and erythropoietin receptor expression in human prostate cancer

“…40 Anemia was reported to develop in 81% of patients with prostate cancer after receiving neoadjuvant combined androgen blockade and pelvic radiotherapy. 41 In another study, combined hormonal blockade was associated with a significant decrease in hemoglobin in 90% of patients; this decline was related to the duration of treatment and recovered after treatment of symptomatic patients with recombinant human erythropoietin. 42 In a randomized study of patients with anemia and metastatic hormone-refractory prostate cancer, administration of higher doses of recombinant human erythropoietin was associated with increased hemoglobin, reduction of blood transfusions and improvement in quality of life compared to lower erythropoietin doses.…”

Hematological changes during androgen deprivation therapy

“…41 In a prospective study of 147 prostate cancer patients receiving CAB, hemoglobin levels declined significantly in all patients from a mean baseline of 14.9 g dl 21 to means of 13.9, 13.2 and 13.1 g dl 21 at 1, 2 and 3 months, respectively. Hemoglobin levels continued to decline during CAB to a mean nadir of 12.3 g dl 21 at a mean of 5.6 months of CAB, representing a mean absolute hemoglobin decline at nadir of 2.5 g dl 21 .…”