Androgen deprivation therapy (ADT) for prostate cancer (PCa) may increase the risk for anemia and other hematologic disorders, new research suggests.

Among 13,318 patients diagnosed with PCa in Taiwan’s National Health Insurance Research Database, 1997 to 2013, a total of 8122, 1797, and 3399 were treated with ADT only, radiation therapy (RT) only, or radical prostatectomy (RP) only, respectively. By design, no one could have received chemotherapy. Investigators defined 3 treatment groups of 1797 patients each using propensity-score matching for further analysis.

Overall, hematologic disorders developed in 787 patients during a median follow-up of more than 4 years. Compared with the RP group, men treated with ADT had a significant 1.63-fold increased risk anemia and 1.60-fold increased risk for hematologic disorders overall in adjusted analyses, Jui-Ming Liu, MD, of Taoyuan General Hospital, and colleagues reported in PLOS One. The study found no significant increase in the risk of hematologic malignancies associated with ADT use. RT patients had significant 1.92- and 2.48-fold increased risks for anemia or hematologic malignancy, respectively. Patients with bone metastases who received only ADT had a 2.87-fold greater risk for hematologic disorders overall.

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Longer duration of ADT use was associated with higher risks. Taking ADT for 12 months or more was associated with the highest risk — a 1.85-fold increased risk for hematologic disorders overall — whereas ADT use for less than 12 months was associated with a 1.56-fold increased risk. 

ADT included gonadotropin-releasing hormone (GnRH) agonists (leuprolide, goserelin, buserelin, and triptorelin), oral antiandrogens (cyproterone acetate, bicalutimide, flutamide, and nilutamide), and estrogens (diethylstilbestrol and estramustine). GnRH use was associated with significant 2.82- and 2.75-fold increased risks for anemia and hematologic disorders overall, whereas the oral antiandrogens alone were associated with significant 1.80- and 1.79-fold increased risks, respectively. Estrogen use was not associated with increased risks of any hematologic disorders.

In a discussion of study limitations, the authors noted that PCa characteristics, including PSA level, clinical stage, and Gleason scores were not captured in the database, precluding any assessments by disease severity.

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Liu J-M, Liu Y-P, Chuang H-C, et al. Androgen deprivation therapy for prostate cancer and the risk of hematologic disorders. PLOS One. 15(2):e0229263. doi: 10.1371/journal.pone.0229263