Increased Risk Of Hematologic Disorders Seen With Androgen-Deprivation Therapy

Androgen-deprivation therapy (ADT) for prostate cancer is associated with an increased risk of hematologic disorders, according to data from Taiwan.

"In the management of prostate cancer patients treated with ADT, periodic check of hemoglobin, white blood count, and red blood count is a routine practice," Dr. Ren-Jun Hsu of the National Defense Medical Center, in Taipei, told Reuters Health by email. "Physicians may take anemia and hematologic malignancy into consideration if they find symptoms or signs in patients with ADT."

ADT is a cornerstone of treatment for advanced prostate cancer. While it has been associated with anemia, it remains unclear whether ADT is associated with hematologic malignancies.

Dr. Hsu and colleagues used data from Taiwan's Registry for Catastrophic Illness Patient Database to evaluate whether the use of ADT in men with prostate cancer is associated with the subsequent development of hematologic disorders, including anemia and hematologic malignancy.

The study included 8,122 men who received only ADT, 1,797 who received only radiotherapy (RT), and 3,399 men who underwent radical prostatectomy (RP) only. The propensity-score-matched analysis included 1,797 men in each group.

Overall, 787 patients developed hematologic disorders during a median follow-up period of 4.32 years. The incidence of hematologic disorders per 1,000 person-years was 28.18 in the ADT group, 36.01 in the RT group, and 17.07 in the RP group, the researchers report in PLoS ONE.

The incidence of hematologic malignancy per 1,000 person-years were 1.93 in the ADT group, 3.96 in the RT group, and 1.80 in the RP group.

After adjusting for age, comorbidity and use of other medications, the risk of developing hematologic disorders was 60% higher (P<0.001) in the ADT group and 98% higher (P<0.001) in the RT group, compared with the RP group.

The risk was even higher among men treated with ADT who presented with bone metastases, and the risk of hematologic disorders increased with increasing duration of ADT.

The risk of hematologic disorders was increased 2.75-fold among users of GnRH agonists and 1.79-fold (both P<0.001) among users of oral antiandrogens, but the use of estrogen was not associated with an increased risk of hematologic disorders.

"Our study showed another possible complication of ADT," Dr. Hsu said. "Further studies are needed to have a better understanding (of the association) between ADT and hematologic disorders."

Dr. Laurent Azoulay of McGill University, in Montreal, Canada, who has researched the unwanted consequences of ADT, told Reuters Health by email, "The association between ADT (and hematologic disorders) has been shown in previous studies, and this study provides corroboration to these studies."

"It is important for clinicians to be aware that ADT might induce anemia in patients with prostate cancer," he said. "Indeed, this may help avoid unnecessary testing, such as endoscopies, to understand the cause of the anemia."

—Will Boggs MD

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