The Impact of Anemia on PSA Outcome following Radiation and Androgen Suppression Therapy in Patients with High-Risk Prostate Cancer

Diana Stripp, MD
University of Pennsylvania Cancer Center
Last Modified: November 6, 2001

Presenter: A.V. DAmico
Presenter's Affiliation: Brigham and Women's Hospital, Boston, MA
Type of Session: Scientific

It is well known that in men testosterone has a permissive effect on hemeglobin (Hb)levels in the bone marrow and on erythropoetin levels in the kidney. Androgen suppression therapy (AST), frequently used in the treatment of advanced prostate cancer, is known to cause decreases in hemeglobin levels. This is concerning because there is also evidence that anemia is associated with decreased local control in cervix and head and neck cancers. In this study, the investigators examined the relationship between Hb levels and biochemical outcome after radiation therapy (RT) and AST.

Materials and Methods

  • 133 patients treated with 3D-conformal RT between 1997-2000.
  • Median age was 70 years.
  • Patients had 6 months of AST, 2 months before RT, 2 months during, and 2 months after completion of RT.
  • All patients had either clinical stage >= T2c disease or a PSA > 10 ng/ml or a biopsy Gleason score >= 7 disease.
  • PSA failure was the primary endpoint and defined as two consecutive rising PSA values > 1.0 ng/ml.
  • Time of PSA failure was defined as the time of the first rise.


  • On Cox regression analysis, a Hgb level < 13 g/dl at the start of RT was a significant predictor of time to PSA failure.
  • Those patients who had a decrease in Hb levels greater than 1g/dl during the first month of AST had biochemical failure more often than men who had a decline of less than 1g/dl during that same time.

    Author's Conclusions
    Findings suggest that anemia at the start of RT may impact negatively on PSA outcome following RT and AST in high-risk prostate cancer patients.

    Clinical/Scientific Implications

  • It is unclear why a decline in Hb during the first month of AST, and not in subsequent months, causes biochemical failure. The author speculates that it may be related to permanent changes in the bone marrow that take place early in AST. Nevertheless, if this phenomenon is reproducible, it could be used to help choose therapy, and to stratify patients in clinical trials

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