Hesitation before switching from Abiraterone to some other protocol.

[Philly13]

I have been discussing and considering that Abiraterone might be failing. It seems that a steady level in the 4 range for the previous 11 months has moved to the 6 range. July lab results arrived yesterday. I switched from prednisone to dexamethasone in the last week of June. Dexamethasone is more powerful and more uncomfortable than prednisone. I am more fatigued and my glucose is higher. It is manageable.

I don't understand the increase in WBC and the decrease in RBC. If someone can help me with insight into possible reasons, it would be much appreciated.

The numbers for RBC, Hemoglobin, and Hematocrit are below the normal range, but not by much.

Also, Iron dropped to 44 from 91. Perhaps there are some signs of anemia?

I am concerned about the PSA plateau increasing to another neighborhood, but it is steady.

I have an appointment with the oncologist on Thursday. We planned to discuss steps following Zytiga/prednisone.

As I look at these numbers, combined with feeling pretty good, my current mindset is to be patient and give the dexamethasone more time to interact.

PSAMarAprMayJunJul

4.57.36.06.46.3

Dec Jan Feb Mar Apr MayJune Jul

WBC4.8 5.2 5.4 5.6 4.8 4.8 4 7.4

RBC 4.47 4.564.45 4.38 4.18 4.67 4.32 3.97

HGB 13.4 13.7 13.5 13 12.5 14.1 13.1 11.9

HCT 40.8 41.7 40.2 38.3 37.1 42.2 39.4 36

ALP 61 57 61 69 70 78 77 73

LD 139130 132 162 185 173 167 137

The above are all very preliminary thoughts.

[LearnAll]

Lets first discuss increase in WBC. Commonest cause of increase of WBC is infection somewhere in the body as WBCs are recruited to contain and fight the infectious agent.

In your case, I do not think its infection. You are on a heavy duty corticosteroid, Dexamethasone...which causes increase in WBC. Its not of much significance and is usually harmless to see higher WBC numbers due to prednisolone or dexamethasone.

I think you already know that there is something called "anemia of cancer" In case of prostate cancer, Hb declines but its level goes only 2 or 3% down in most cases. And that can cause easy tiredness with exercise but is not much of a problem. A Hb of >12.5 is considered fine.in people with PCa.

In very very late stage (terminal) ,if bone marrow invasion occurs due to deeper bone mets, RBCs will go way down continuously and sometimes blood transfusion might be needed. But, this is not true about your case as your anemia is mild and consistent with normal effect of prostate cancer. Also, in cases of bone marrow invasion, WBCs do not go up BUT they also go down. All cells, RBC, WBC and thrombocytes ..all of them go down and it is called "Pancytopenia" ...YOU DO NOT HAVE IT..so please relax..its not that bad.

I just noticed that your Hb reached 11.9% and hematocrit is 36 which is low. Did you drink a lot of water before blood draw? That can cause lower hematocrit. Recheck Hb without any water for 8-10 hours.

If your MCV and MCHC and serum Iron are also low...then it raises the possibility of Iron deficiency anemia which can be easily confirmed by looking at your RBCs under the microscope. Iron deficiency anemia causes smaller red cells which are not as colorful as normal red cells.

[Philly13 in reply to LearnAll]

Thank you very much. I try to drink a lot of water all the time, but seem to be especially conscious of it when going for labs. I did drink quite a bit of water the night before and morning of the labs. All of the information in your reply is very helpful.

All my best,

Philly

[Philly13 in reply to Philly13]

Do you have thoughts on whether to be patient with Zytiga, while waiting for more experience with dexamethasone?

[LearnAll in reply to Philly13]

Not to change Abi abruptly. Closer monitoring of PSA, Alk Phos, Albumin, Hb and CRP is needed before major decision to switch to other med is made.

Also, the lab error about blood parameters need to be fixed.

[Philly13 in reply to LearnAll]

What lab error are you referring to?

[Philly13 in reply to Philly13]

For the sake of clarity. I did not think the RBC was higher than normal. My curiosity was sparked by a 75% increase from the level it was every month for more than a year. I am curious, more than concerned. Your comments were very helpful in putting all that in perspective. thanks again.

[LearnAll in reply to Philly13]

By lab errors, I mean the possible lower readings of RBCs and Hematocrit...due to Hemodilution...meaning drinking excessive amount of water before tests make the blood diluted and readings of test gets inaccurate.

So I suggested to NOT drink water or any drink for 8 hours before blood draw...to get accurate RBC and hematocrit values.

[Tall_Allen]

Your WBC is normal at 7.4. As you said, your RBC is a little low but not by much. Maybe some iron deficiency. Maybe check ferritin and B-12.

[Philly13 in reply to Tall_Allen]

Do you have thoughts on whether to be patient with Zytiga, while waiting for more experience with dexamethasone?

[Tall_Allen in reply to Philly13]

I think that you should wait for a sign on imaging that there is progression.

[tango65]

ADT causes a decrease in the RBCs and hemoglobin. If the MCV and MCH are normal, most probable this anemia is caused by the castration.

[Philly13]

MCV and MCH are normal. Thanks. I am going to address anemia and sit tight on ADT.

[Hirsch in reply to Philly13]

A hematocrit of 36 is low for a male. You might consider looking into causes of slow blood loss. GI slow bleed for example.