Development of anemia and recovery in prostate cancer patients treated with combined androgen blockade and radiotherapy.
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 > or = 1 g/dl (mean +/- SE, 2.1 +/- 0.1 g/dl) in 98/131 patients (75%) after 2 months of CAB, and > or = 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 decreased 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 approximately 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.
Asbell
S O
SO
Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
Leon
S A
SA
Tester
W J
WJ
Brereton
H D
HD
Ago
C T
CT
Rotman
M
M
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000740:Anemia / Q000097:blood / Q000139:chemically induced*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D044383:Black People; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005485:Flutamide / Q000627:therapeutic use; D017273:Goserelin / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D010388:Pelvis / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000532:radiotherapy*; D012074:Remission Induction; D044465:White People; D001741:Black or African American
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins; D017273:Goserelin; D005485:Flutamide