Hemoglobin, Testosterone, and Erythropoietin in Prostate Cancer

Prostate cancer is the most common malignancy among North American men, and radiation and total androgen blockade (tab) are commonly used treatment options. In metastatic prostate cancer, tab is considered first-line treatment; it is also used in the treatment of both locally advanced and recurrent prostate cancer1,2. Although not routinely recommended as first-line therapy for the management of early-stage prostate cancer, tab is increasingly being used for clinically localized prostate cancer as well3. The benefit of tab in addition to radiotherapy has been demonstrated in the treatment of highand intermediate-risk localized prostate cancer4,5, but its role in earlier-stage disease remains controversial and is an area of active clinical research. Some well-known toxicities are associated with tab. It has long been known that anemia can develop in patients undergoing orchiectomy, which was the first form of tab, albeit surgical. Serum testosterone was found to decline significantly within 10 days of orchiectomy and that decline in testosterone was followed by a decline in serum hemoglobin (approximately 10 g/L within 40 days)6. Newer approaches to tab have largely included the use of luteinizing hormone–releasing hormone (lhrh) agonists and antiandrogens that are thought to have similar ABSTRACT