anaemia and ADT

[SimMartin]

just had full blood test before I press on with ADT aiming for 18 months and done 9 months adjuvant with RT for G9 - as posted before my oncologist seems to lean to me stopping ADT now as worries about the effect in my polio - though she isn’t a polio expert of course, she just thinks the extra gain is not that great over 10 years.

but my worry is that I am becoming anaemic with my results as below - I read somewhere that anaemia can be an ADT/low T problem but it isn’t usually due to low Iron - And taking iron May not be an appropriate response.

Any others had this or ideas as to the seriousness of this so far and if it is to do with the ADT ?

Haemoglobin low

120 g/L down from 126 last April and 127 in September 2022

(Pre PCa treatment normal of between 134 and 140 g/L at best)

haemotacrit low

0.368 L/L normally low but down from last April 0.385 L/L and 0.378 in September 2022

RBC low

3.98 10*12/L down from 4.1 last April previously 4.27 in september 2022

(always borderline low due to life long polio breathing insufficiency but obviously extra risk for me with ADT.)

however :

MCV, MCH, MCHV, ferretin, folate, B12, all in normal range.

I did have slightly raised potassium and birding sodium in my test for U&Es but it was an insanely hot day and I know sometimes the sample can be damaged cells when taken as happened to me before and normal on retest.

[Mike1971]

Hi SimMartin,

My haemoglobin was in the normal 140 g/L range before, but is now anemic at 110 g/L (up from 105 g/L in June). My doctor isn’t sure why - it could perhaps be due to the ADT, but I have had lots of problems with bleeding from radiation damage which also could be the explanation.

[SimMartin in reply to Mike1971]

Thanks for that, I unsure too if it’s related to the ADT or my other polio breathing issues. Have managed to see much on anaemia and ADT or what to do! Did you doctor treat it in anyway or see it as a major problem at that level ?

[Mike1971 in reply to SimMartin]

As I recently ended ADT (last lupron shot in January and last Abiraterone pill in July), and also did a argon treatment in August to stop my bleeding problem, my doctor and I decided to wait and see - hoping my haemoglobin levels will normalize.

[Amadeus71]

My RBC, hematocrit and hemoglobin were all well within the normal range at the start of treatment in January 2022, then all dropped to the low end of normal range and have stayed there. Treatment included Casodex for 30 days then stopped, lupron injections once every 30 days, Xgeva once every 30 days, Zytiga and prednisone daily. I changed from Lupron to daily Orgovyx in May 2022, and still on it along with Zytiga and prednisone. Xgeva changed to 60 day intervals January 2023.

[timotur]

My RBC's went from 4.39 pre-dx, down to 3.72 during ADT/radiation tx, and now back to 4.11 three years after my last Lupron shot. (normal: > 4.2)

Ditto WBC's, went from 4.6 to 2.7, and now 3.9 (normal: > 3.8).

Both took a hit slowly climbed back to the lower limit normal.

[SimMartin in reply to timotur]

So was there any treatment offered to support the drift down or was it seen as just part of the low T and ADT and monitored thought not seen as critically low ?

[timotur in reply to SimMartin]

No treatment was prescribed. For WBC’s, not much you can do as pelvic radiation hits the lymphocyte producing CD4+ cells in the pelvis. For RBC’s, ditto, but one can boost platelet production through diet/exercise— my routine is beef liver 1x/week and weight lifting 3x/wk along with running/tennis and a Mediterranean diet.

[dhccpa]

I've been on Lupron only for almost five years. The same three readings have been below normal range since I began. White cells and platelets are fine.

Sodium is below normal range. Potassium normal mostly, but sometimes high.

I think the MO attributes all this to Lupron.

[SimMartin in reply to dhccpa]

Thanks for that - and yes my last potassium was high which is unusual. So seems about the low T effects again - I already am always a bit low on Hb etc but hopefully it will stabilise at this lower level and not go lower

[rsgdmd]

Mild anemia is a known side effect of ADT. Docs don't get concerned as long as the numbers don't stray too far from normal.

[SpencerBoy11]

Although it is rare, radiation or chemotherapy can cause MYELODYSPLASTIC SYNDROMES (MDS). I was dx with anemia and a bit later with hemochromatosis (too much iron)! Then had a bone marrow biopsy which discovered the MDS with ring sideroblasts. Not much can be done, but at least knowing helps the mind and answers some Unexplained SE.

[SimMartin in reply to SpencerBoy11]

Hopefully I don’t have that - got enough going on ! Sorry you have to deal with it

[Justt]

I'm on Zoladex since march /23 and now my hemoglobin went down a bit too... I'm having a pescatarian diet since a long time, and I'm now taking VitD and Zinc supplementation only. After diagnosis I do avoid taking those full spectrum vitamins..

[SimMartin in reply to Justt]

Thanks - it’s reassuring to know it’s a normal abnormal for those of us on ADT, another SE to get on with and watch it doesn’t get too bad!

I more or less like you am eating fish and kind of Mediterranean diet as my wife has Spanish background so have done pre diagnosis just been a bit more so since. The whole extreme diet stuff can do my head in around no dairy ir meat at all.

Also I have taken Vit D for years (recently added k2) also stopped all other multivitamins etc since starting HT and the RT.