Spike in RBC. What does it mean?

[BigM62]

I am 56. Diagnosed straight to advanced stage 4 in July 2017. PSA 11 and discovered due to severe nerve back pain. Extensive spine Mets.

I started ADT within days and chemo within a week. Did 10 rounds and ended in february 2018. End of chemo my PSA was 0.01 and scans showed no remaining visible Mets.

Since then, my WBC is chronically low, but MO said that is my new normal post chemo and does not treat it. My RBC has also been lower since then. And suprisingly my platelet count has been normal. I have a history of a lower platelets around 100 although during and post chemo it’s been higher.

Suddenly today at my 6 week interval CBC, my RBC has spiked to 6.4. My wbc is still low at 2.07. And my platelets plunged to 42.

I’m not all that concerned about the platelets although it’s really low even for me. But I can’t find any google reason for the RBC spike. Is my body suddenly recovering from chemo all at once? Or is this an indication of tumor activity and my PSA is going to start to rise?

I get my full metabolic panel results in a few days to check my PSA and others. 6 weeks ago alk phos was normal and PSA was still undetectable.

I’ve been feeling stronger and the only other change is that I was put on physical therapy for back. So I’m getting a bit more excercise.

What can be the reason?

[pjoshea13]

BigM,

We are used to ADT causing a drop in RBC to near anemia, so your number is interesting.

You have "been feeling stronger" & I suppose that the increase in oxygen due to higher RBCs might have something to do with that.

I have no idea why your RBC would be so high - the LabCorp range is 4.14 - 5.80. If you get an answer, please pass it on.

-Patrick

[BigM62 in reply to pjoshea13]

I will do. Unfortunately next MO discussion is 6 weeks. I did read that there is a name for this - polycythemia (my hemoglobin and hemp rats were also high). Causes of polycythemia seem very far out of scope of what is probable for me. I don’t have COPD, or chronic smoking, etc. Can be correlated to kidney issues - I’m not expecting that but a possibility if Pca is progressing. Also possible from dehydration? I will hydrate a lot before next test. I don’t feel dehydrated but I have been excercising more.

Or maybe it’s something strange from my platelet issue.

Anyway, relieved for now that there is not an obvious connection to cancer progression.

I will report more if a doctor weighs in.

[pjoshea13 in reply to BigM62]

BigM,

I cycle between castrate testosterone [T] & high-normal (>1,000) & am used to seeing RBC fall & then recover into the middle of the normal range. I have heard that some men on T replacement see RBC rise too high & that this comes with risk of a blood clot.

The D-dimer test can be used to monitor one's clotting status. D-dimer = ~0 always means no active clot.

I use nattokinase to take care of unwanted clotting.

-Patrick

[Lombardi24 in reply to pjoshea13]

Patrick. Are you recvng BAT therapy?

[pjoshea13 in reply to Lombardi24]

For a number of years I was on a 3+3 monthly cycle, i.e. 3 months to get PSA close to zero, followed by 3 months of T patches.

A few moths ago, I decided to try the more rapid BAT cycle - a single high T dose by injection at the start of each month & castrate by mid-month or so.

-Patrick

[Lombardi24 in reply to pjoshea13]

My doc wont do it. She refuses. How is it working? Does it bring PSA down? T must make you feel better.

[pjoshea13 in reply to Lombardi24]

I was on continuous T for over 5 years & I had a good PSA doubling time [PSADT] for much of that time. I felt good. I once joked that while I do have cancer, at least I have my health.

But then the PSADT shortened to the point where I had to consider ADT. I decided to do rapid cycling in order to delay CRPC. It seemed reasonable that a short period of castrate T might avoid avoid the more nasty adaptive changes, particularly if followed by T > 1,000 ng/dL. & it was an easy schedule to be on. Life was very good for at least half of the time.

I'm not sure what to make of the BAT schedule. One injection per month isn't the same as getting 3 months T at a time. The T from a muscle injection is slow to clear. I know that my T has been ~1,000 ng/dL eight days after an injection.

I need to get a few more end-of-month PSA readings before I can say whether BAT is a success for me.

-Patrick

[Lombardi24 in reply to pjoshea13]

If you dont mind me asking...what exactly was therapy considered? I'd like to tell my onc about it. So...it wasn't BAT but you were still receiving T and Lupron or another ADT drug?

[pjoshea13 in reply to Lombardi24]

I had an early interest in intermittent ADT [IADT], but it seems that less than 12 months on ADT does not lead to a durable off-phase. But with a 12 month on-phase, CRPC sets in by the third cycle. So I wanted IADT with a shorter cycle.

With a 12 month IADT on-phase, T doesn't bounce back quickly. I feel strongly that T should be restored if possible. So I wanted an off-phase with T restored. I settled on 3-month phases. It was my pre-BAT concoction, intended to forestall CRPC.

I had access to an otc product that was likely spiked with DES. You can't get it any more & my stash is 10 years old.

My doctors have been supportive & I can switch to low-dose DES at any time.

Lupron may very well be in my future, but I have resisted for 14 years.

-Patrick

[Lombardi24 in reply to pjoshea13]

I am already at CRPC. I was a year post surgery. So T may not be in my best interest I guess (I have mets on pelvis). I had just read where BAT cause PC to die

[pjoshea13 in reply to Lombardi24]

Some men with CRPC respond to T restoration. Some, surprisingly, respond to DES.

I will try to get you the studies tomorrow.

-Patrick

[Lombardi24 in reply to pjoshea13]

Okay. Thank you Patrick. What is... DES?

[ctarleton in reply to Lombardi24]

DES = Diethylstilbestrol

In the advanced prostate cancer setting, see, e.g.:

macmillan.org.uk/informatio...

Less prescribed now, since the more recent availability of other drugs in more recent years.

In the infamous general medical disaster setting, see:

cancer.gov/about-cancer/cau...

(My older daughter was exposed to DES in utero in 1969 during the care her mother got from US military doctors. As an adult she suffered many of the unfortunate and disastrous consequences.)

[pjoshea13 in reply to Lombardi24]

I think that this 2017 paper covers the subject of T therapy in CRPC:

ncbi.nlm.nih.gov/pmc/articl...

DES is Diethylstilboestrol:

en.wikipedia.org/wiki/Dieth...

See: "Diethylstilbestrol for the treatment of patients with castration-resistant prostate cancer ...":

ncbi.nlm.nih.gov/pubmed/242...

-Patrick

[Lombardi24 in reply to pjoshea13]

Thx Patrick

[Atwig in reply to pjoshea13]

Patrick

What is the frequency of your T cycles?

Art T

[pjoshea13 in reply to Atwig]

Art,

See my reply to Lombardi24, above.

-Patrick