Hematological changes during androgen deprivation therapy

Abstract

Androgen deprivation therapy (ADT) has been associated with a plethora of adverse effects, consistent with the androgen dependency of multiple reproductive and somatic tissues. One such tissue is the hemopoietic system, and one of the most predictable consequences of ADT is the development of anemia. Although anemia caused by ADT is rarely severe, ADT is often given to frail, elderly men with increased susceptibility to anemia due to multiple other causes. ADT-associated anemia may contribute to fatigue and reduced quality of life (QoL) in such men, although this requires further study. While anemia is an independent risk factor of mortality in men with prostate cancer, it is not known whether treatment of ADT-associated anemia alters clinically important outcomes, or whether treatment affects mortality. Awareness of the phenomenon of ADT-induced anemia should avoid unnecessary work-up in mild cases of normocytic normochromic anemia. However, assessment and treatment of more severe anemia may be required. This should be determined on an individual basis. In contrast to the well-described actions of ADT on erythropoiesis, its effect on other hemopoietic lineages has been less well elucidated. While preclinical studies have found roles for androgens in maturation and differentiated function of neutrophils, lymphocytes and platelets, the implications of these findings for men with prostate cancer receiving ADT require further studies.

Survivorship and Improving Quality of Life in Men with Prostate Cancer

“…[30] Briefly, these include increased fracture risk, [31] metabolic consequences and cardiovascular events, [32][33][34][35][36] genital and sexual dysfunction, [37,38] fatigue [39] and anaemia. [40] The association between ADT and cardiovascular risk remains controversial and this has been discussed elsewhere. [33,36,41] …”

Hormonal therapy in advenced stage prostate cancer

“…Hafif-orta derece anemilerde tedavi önerilmezken, myelofitizi, sınır-lı kemik iliği rezervi, ağır derecede ya da sempto-matik anemi durumlarında eritropoez stimüle edici ajanlar, ya da düzenli kan transfüzyonları gerekli olabilmektedir. [44] …”

Estradiol for the mitigation of adverse effects of androgen deprivation therapy

“…This is clearly an androgen-dependent effect. The mechanisms may involve reduced activation of AR on erythroid progenitors, unsuppression of hepcidin leading to reduced iron availability for erythropoiesis, and possibly reduced erythropoietin secretion, although data are contradictory (Grossmann & Zajac 2012).…”

“…Fatigue is likely to be multifactorial. Androgen ablation produces a mild normocytic anaemia, with haemoglobin and haematocrit within the female normal range (Grossmann & Zajac 2012). Hot flushes are experienced by approximately 70-80% of men undergoing non-estrogen-based ADT (Karling et al 1994, Sharifi et al 2005.…”