How are hemoglobin levels affected by androgen deprivation in non-metastatic prostate cancer patients?
OBJECTIVE
To examine the change of hemoglobin in relation to testosterone level in non-metastatic prostate cancer patients receiving 2-year androgen suppression.


METHODS
A cohort of 72 patients, as participants of a phase II study, were treated with adjuvant radiotherapy plus 2-year androgen suppression after surgery to reduce the risk of relapse. Patients had laboratory tests including hemoglobin (Hb) and testosterone, and a quality of life questionnaire at regular intervals during the androgen suppression and post-androgen suppression period. The pattern of the change in Hb was evaluated in relation to testosterone level. The clinical significance of Hb change was assessed with a correlation analysis between Hb and the three domains of the questionnaire (global health status, physical functioning, and fatigue).


RESULTS
Median age was 64.2 years. Median follow-up was 37 months. Mean Hb at the baseline was 148.4 g/L. It declined slightly with radiotherapy by 2.2 g/L. Maximal Hb decline during androgen suppression was 10.5 g/L (p < 0.0001), occurring at 24 months after the initiation of androgen suppression. In most patients, Hb decline was < 20 g/L. In the post-androgen suppression period, the recovery of Hb was slow and followed that of testosterone. The three quality of life domains did not show any significant correlation with the change in Hb.


CONCLUSIONS
The decline and recovery of Hb was closely related to that of testosterone. Two-year androgen suppression resulted in a statistically significant decline of Hb, which had, however, no clinically apparent adverse effect on the three quality of life domains.
Choo
Richard
R
Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Chander
Sarat
S
Danjoux
Cyril
C
Morton
Gerard
G
Pearce
Andrew
A
Deboer
Gerrit
G
Szumacher
Ewa
E
Loblaw
Andrew
A
Cheung
Patrick
P
Woo
Tony
T
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D000740:Anemia / Q000209:etiology*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002064:Buserelin / Q000627:therapeutic use; D017322:Clinical Trials, Phase II as Topic; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D048289:Imidazolidines / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000097:blood* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D018434:Sickness Impact Profile; D013739:Testosterone / Q000097:blood
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins; D048289:Imidazolidines; D013739:Testosterone; C021277:nilutamide; D002064:Buserelin