Hemoglobin.

[pjoshea13]

New Swedish study, below [1].

I don't know what to make of it.

I know from my BAT-like protocol that low testosterone [T] causes red blood cell [RBC] levels to fall, and that T restoration restores normal levels.

RBCs contain hemoglobin, which carries oxygen from the lungs.

Dr. Myers complained about GPs who blindly treated anemia in his patients with iron. Men do not need iron supplements, in general, & iron deficiency is an unlikely cause of anemia in men. Men on ADT are often borderline anemic, but the last thing they need is to have dangerous levels of iron too.

In a 2016 study [2]:

"Subjects with low {serum total testosterone} and {free testosterone} levels had low {serum hemoglobin} and {serum hematocrit} levels."

{Hematocrit is the volume of RBCs - normally ~40% in men.}

Anyway, up to now I have viewed reduced hemoglobin as just an artifact of hypogonadism & ADT.

The new study looked at "the strength of change in haemoglobin levels during one year of ADT as a predictor of survival in hormone naive prostate cancer patients with bone metastases."

"... changes in haemoglobin level between baseline and 3 months showed better survival in patients with a decrease in haemoglobin (HR 1.42 ...) compared to those with an increase, while no difference in survival associated with change in haemoglobin between 3 and 6 months was observed"

"Contrary to the first three months, poorer survival was observed in patients with a decrease in haemoglobin between 6 and 12 months (HR 0.76 ...) compared to those with an increase."

"In a large cohort of Scandinavian men with bone metastatic hormone-naive prostate cancer, an increase in haemoglobin level between baseline and three months of ADT was associated with significantly poorer survival whereas an increase between six and twelve months was associated with better survival."

So, the best prognosis is for men who see a drop in the first 3 months, but no further drop from month 6 onward - in fact, an increase thereafter is best.

Not clear to me how one would use the info. or influence hemoglobin levels.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/296...

BJU Int. 2018 Apr 2. doi: 10.1111/bju.14227. [Epub ahead of print]

Clinical and Prognostic Significance of Changes in Haemoglobin Level During One Year of Androgen Deprivation Treatment for Hormone-Naïve Bone Metastatic Prostate Cancer.

Ebbinge M1, Berglund A2, Varenhorst E3, Hedlund PO4, Sandblom G5; spcg-5 study group.

Author information

1

Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet Department of Urology,, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.

2

EpiStat, SE-756 55, Uppsala, Sweden.

3

Department of Urology, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden.

4

Department of Urology, Karolinska Institute, SE- 171 77, Solna, Sweden.

5

Department of Clinical Science and Education Södersjukhuset, Karolinska Institute Stockholm,, Department of Surgery Södersjukhuset, Stockholm,, Sweden.

Abstract

OBJECTIVE:

To estimate the strength of change in haemoglobin levels during one year of ADT as a predictor of survival in hormone naive prostate cancer patients with bone metastases.

MATERIAL AND METHODS:

The patients included in this study were taken from the randomised trial (No.5) carried out by the Scandinavian Prostate Cancer Group (SPCG), comparing parenteral oestrogen with total androgen blockade (TAB) in hormone-naive metastatic prostate cancer (category M1b). We identified 597 men where haemoglobin measurements were made at enrolment as well as at three, six and twelve months of ADT. The time-dependent impact of haemoglobin changes on overall survival was analysed using multivariate Cox proportional hazards analysis. Overall 10-year survival according to increase/decrease in haemoglobin level for the three treatment periods was demonstrated using Kaplan-Meier curves.

RESULTS:

Multivariate analysis of changes in haemoglobin level between baseline and 3 months showed better survival in patients with a decrease in haemoglobin (HR 1.42, CI 95% 1.11-1.80) compared to those with an increase, while no difference in survival associated with change in haemoglobin between 3 and 6 months was observed (HR 0.93, CI 95% 0.76-1.12). Contrary to the first three months, poorer survival was observed in patients with a decrease in haemoglobin between 6 and 12 months (HR 0.76, 95% CI 0.62-0.92) compared to those with an increase.

CONCLUSIONS:

In a large cohort of Scandinavian men with bone metastatic hormone-naive prostate cancer, an increase in haemoglobin level between baseline and three months of ADT was associated with significantly poorer survival whereas an increase between six and twelve months was associated with better survival. These findings provide new information about patterns of change in haemoglobin levels during 12 months of ADT for bone-metastatic (M1b category) prostate cancer, and survival. Clinicians should be aware of the prognostic value of haemoglobin changes during ADT in M1 prostate cancer, where increases in haemoglobin during the first 2 quarters and last six months of the first year of treatment are associated with poorer and better survival respectively. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 29611275 DOI: 10.1111/bju.14227

...

[2] ncbi.nlm.nih.gov/pubmed/277...

[pjoshea13]

Nala,

Yes, I should have remembered your situation.

But, as Dr. Myers said on his vlog, if a man has low iron, one is told in medical school to suspect internal bleeding. Unless one is a vegan, the diet has plenty. Crazy that doctors would prescribe iron without even checking levels.

I have a strange situation in that my ferritin keeps going up. Occassional phlebotomy brings it down. My integrative doctor sats that it is generally a reliable indicator of iron stores, but I don't eat an iron-rich diet. Maybe it's "empty" ferritin. Maybe I'm holding on to the iron I do ingest. Whatever.

-Patrick

[pjoshea13]

Thanks! -P

[Stegosaurus37]

I've been slightly anemic all my life. Iron supplements had no effect on the anemia but screwed up some other stuff, so I said just live with it which I have done successfully. Lupron and docetaxcil plus prednisone and casodex haven't changed my anemia one iota. Some things seem to be totally independent.