Blood count concerns

[shueswim]

It’s been a while since I’ve posted...and that’s a good thing. PSA undetectable since treatment began in Jan. ‘19 for recurrent G9 PCa with a 2 month PSADT. After a F-18 DCFPyL PSMA scan located the recurrence in a handful of pelvic area LNs, I began monthly Firmagon shots, Zytiga/prednisone...and hit the LNs (and all those in the vicinity) with RT. RT ended in May and now the plan is to continue on with the other measures thru next May. And then I stop all treatment...and see what happens. My local RO working together with Dr Zietman at MGH put together this plan of attack.

So...all things considered I’m doing well. My MO however has become increasingly concerned about my bloodwork. Since January my RBC have been dropping and have now leveled off at about 4.0 just below the normal range. My WBC has fallen further to 3.0 (normal range = 4.2-10.0). Lymph % is 8.2% (normal: 15-40%) and the Lymph# is at 0.26 (normal 1.2-3.4). I meet with the MO next week and I expect that he’ll want to draw some bone marrow for testing.

Has anyone else experienced this kind of impact from ADT and RT on blood counts? Is it possible that the PCa has migrated to my blood marrow? Wouldn’t my PSA rise if it had? If not PCa, could I be looking at lymphoma, caused by all the radiation I’ve been exposed to (8 weeks post prostatectomy back in 2016, in addition to this year’s LN RT)? After so many ups and downs over the past 4 years, I start to expect the worst.

[Blueslover]

Can't give you advice Gene, but good to hear from you again and to know that you are having some success.

Cheers, Hugh

[shueswim in reply to Blueslover]

Good to hear from you Hugh! Give a yell if you plan to be in SW FL anytime soon.

[Blueslover in reply to shueswim]

Need a trip sometime. Like to visit you and a couple of other friends. Will keep it in mind.

Be well

[rust]

Gene, I think everything will be OK. My guess is that your intestines are not absorbing enough nutrients after your RT. If you have not seen a nutritionist or integrative health physician that tests your nutrient blood levels please do ASAP. When on drug therapy, radiation and chemo nutrition can make all the difference in blood counts. I had a low blood count recently (normal) and I immediately began supplementing with C, B and making sure I get enough protein daily which is necessary for the marrow to produce blood cells. My young oncologist laughed at me last week when I told him about. Love ya brother. Russ

[shueswim in reply to rust]

Back at ya Russ. I hope you’re right but I’m pretty careful about nutrition and supplementation. Of course, if it’s not being absorbed it doesn’t much matter what’s being consumed.

Drop me a line to let me know how you are doing.

[Tall_Allen]

Most likely cause is ADT.

[westof]

Hmm... I don't know if this helps, here is a reply that I made recently:

I started Lupron and Casodex exactly 1 year ago (quarterly injections) and shifted to Zytiga, prednisone and Lupron in March. My MO indicates another 22 months of treatment.The only side effects I've experienced are loss of libido and ED. I turn 71 in December. G9, stage 3 and high PSA was 28 (no mets). HDR Brachy (April 26th) and 25 days of IMRT. PSA has held steady at <0.014.

Also, here is my latest CBC:

Component Results

ComponentYour ValueStandard Range

WBC4.6 x1000/µL4.8 - 10.8 x1000/µL

RBC3.3 M/µL4.3 - 5.9 M/µL

Hemoglobin11.3 g/dL13.9 - 16.3 g/dL

Hematocrit32.3 %39.0 - 55.0 %

MCV97.3 fL80.0 - 94.0 fL

MCHC35.0 g/dL33.0 - 37.0 g/dL

RDW-CV12.4 %11.5 - 14.5 %

Platelets204 x1000/µL150 - 420 x1000/µL

MPV10.7 fL8.5 - 9.0 fL

ANC (Abs Neutrophil Count)3.7 x 1000/µL2.2 - 7.2 x 1000/µL

Neutrophils80.9 %45.0 - 90.0 %

Lymphocytes7.4 %10.0 - 50.0 %

Absolute Lymphocyte Count0.3 x 1000/µL0.5 - 5.4 x 1000/µL

Monocytes10.2 %3.0 - 11.0 %

Monocyte Absolute Count0.5 x 1000/µL0.1 - 1.2 x 1000/µL

Eosinophils0.4 %0.0 - 4.0 %

Eosinophil Absolute Count0.0 x 1000/µL0.0 - 0.4 x 1000/µL

Basophil0.9 %0.0 - 2.0 %

Basophil Absolute Count0.0 x 1000/µL0.0 - 0.2 x 1000/µL

Immature Granulocytes0.2 %0.0 - 0.4 %

Absolute Immature Granulocyte Count0.0 x 1000/µL<=3.0 x 1000/µL

nRBC0.0 %0.0 - 0.0 %

Absolute nRBC0.0 x 1000/µLx 1000/µL

MCH34.0 pg25.0 - 35.0 pg

General Information

Collected

10/08/2019 3:15 PM

In August, I emailed my great MO (Dr Richard Frank, search his book) formally of MSK and

asked him if I was anemic. Response:

" Agree, very slight anemia. Treatment is the culprit. Not much we can we can do about it".

Bottom line: I'm not sweating this and I feel great!

Best

[EdBar]

My RBC had fallen to the same level, likely due to ADT. My onco prescribed Fero-Sequels which is an iron supplement, after taking them for a month or two RBC is back to normal. I continue to take them daily and get my blood iron levels checked regularly to make certain they don’t go too high. Thus far they remain well within normal levels.

My WBC and lymph tests fluctuate too, likely from early chemo, neither of my oncologists get concerned.

Ask your doc about Fero-Sequels, you can get them on Amazon, they come in a green box, did the trick for me.

Ed

[andrew61]

Hematologist advised me that when on ADT red cell count drops toward level in females which is lower than males. Lymphocyte count also drops.

[Don_1213]

Quite common ADT side effect for Lupron. Mine is down too... Fero-Sequals look like they'd help if you had iron deficency anemia - but my iron levels are just fine. From the paper "Androgen deprivation therapy - managing side effects" - "Anaemuia: Within 1 month of initiating ADT, most men experience a greater than 10% decline in haemoglobin levels, resulting in a normochromic normocytic anaemia. In 13% of patients this produces symptomatic anaemia, with a resulting decrease in quality of life."

The loss of QOL is due to less oxygen getting to the brain, muscles and other organs. You'll get tired faster, feel weaker and drowsy and have things like muscle cramps. The fun of ADT..

[Blueslover]

I've also been pretty anaemic on ADT. No concern from drs yet

[monte1111]

Diagnosed slightly anemic. Seems to be very common with ADT. Be careful with iron supplements. 30 years ago took wife's pregnancy vitamins, rich in iron. Got very sick. I would check with MO before using vitamins. Learned my lesson. Best of wishes.

[larry_dammit]

Are you working with a Urologist or a oncologist. Sounds like time for scans to me. My Doctor is a medical Oncologist. The best. Haven’t seen the urologist since he blew the diagnoses

[shueswim in reply to larry_dammit]

Scans? PSA undetectable...what would be the purpose. MO may suggest a bone marrow test to diagnose the the blood count issue.

[larry_dammit]

The blood work is how they caught my stage 4. Guess I jumped the gun as I didn’t ask what your diagnoses is

[binati]

I have had 12 sessions of RT and 5 months of ADT. It's the RT that affects WBC, RBC, & Platelet count. All these are low in my case. This is normal but should level off at some point that is not too low. Otherwise one needs some injections to bump up the WBC.