DEVELOPMENT OF ANEMIA AND RECOVERY IN PROSTATE-CANCER PATIENTS TREATED WITH COMBINED ANDROGEN BLOCKADE AND RADIOTHERAPY

BACKGROUND. The objective of this study was to document previously unr eported anemia in prostate cancer patients treated with neoadjuvant co mbined androgen blockade (CAB) and pelvic radiotherapy (XRT). METHODS. Four institutions treated 141 patients (mean age +/- SD, 70.9 +/- 6.5 years) with zoladex 3.6 mg injection subcutaneous depot monthly and f lutamide 250 mg orally three times per day for 2 months (CAB), followe d by zoladex and flutamide with concurrent XRT (65-70 Gy) for 7-8 week s. RESULTS. After the XRT, the patients were randomized to receive no further treatment (Z- group, 71 patients) or zoladex alone (Z+ group, 70 patients) for 2 years. Hemoglobin (Hb) levels decreased greater tha n or equal to 1 g/dl (mean +/- SE, 2.1 +/- 0.1 g/dl) in 98/131 patient s (75%) after 2 months of CAB, and greater than or equal to 2 g/dl (3. 1 +/- 0.1 g/dl; range, 0.1-6.8 g/dl) in 106/131 patients (81%) after a n additional 2 months of CAB with concurrent XRT. The decrease in Hb l evels paralleled the decrease in testosterone levels. No evidence of b lood loss or hemolysis was found. CONCLUSIONS. There was no associatio n between incidence or rate of Hb decrease and race, age, or pretreatm ent prostate-specific antigen (PSA) levels. However, the recovery from anemia after completion of CAB in African-Americans was slower than i n Whites in the Z+ group (P < 0.04). Whereas grade 1 hematologic toxic ity may occur in <5% of the patients with zoladex alone, and similar t o 6% with flutamide alone, in our study 81% showed mild to pronounced anemia. Since anemia has not been observed after treatment with XRT al one or XRT followed by zoladex, we conclude that the anemia was due to CAB. Recognition of this side effect should avoid unnecessary diagnos tic evaluations. (C) 1996 Wiley-Liss, Inc.