anemia and prostate cancer with bone metastasis

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Old 05-26-2009, 10:51 PM
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anemia and prostate cancer with bone metastasis


What treatment would you recomend for an anemic 49 years old Jehovah Witness with prostate cancer and bone metastasis undergoing Androgen Deprivation Therapy therapy? Would you continue with the ADT therapy? Would the EPO and IV iron be of benefit?
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Old 05-29-2009, 09:06 PM
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Originally Posted by Musatye View Post
What treatment would you recomend for an anemic 49 years old Jehovah Witness with prostate cancer and bone metastasis undergoing Androgen Deprivation Therapy therapy? Would you continue with the ADT therapy? Would the EPO and IV iron be of benefit?

Tough but not hopeless situation. Imagine your retic count is low, either from inflammation caused by the cancer, or from the mets crowding red cell precursors out of your bone marrow. Neither EPO nor IV iron will help those problems. You really need to beat the cancer back down through such strategies as:

+ maintain high vitamin D levels (very important with prostate cancer)
+ sodium bicarbonate
+ digestive enzymes
+ alkaline diet
+ low-dose naltrexone / ALA
+ fish oil
+ nutritional support

Androgen deprivation is not without drawback, such as increased risk of death from heart attack. It may also block the benefits of naltrexone.
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Old 05-29-2009, 09:21 PM
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Could the EPo/Iron therapy sill be useful if the metastasis were not crowding RC precursors out of the bone marrow yet? And if there is a blunted erythropoiesis response, could amifostine be useful?

Thank you very much for the answer.
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Old 05-30-2009, 01:49 PM
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Could the EPO/Iron therapy still be useful if the metastasis were not crowding RC precursors out of the bone marrow yet? And if there is a blunted erythropoiesis response, could amifostine be useful?

Thank you very much for the answer.
EPO +/- iron can probably raise the hematocrit, but may also stimulate cancer growth, and trigger thrombosis (blood clots).

Could Ethyol (amifostine) be used off-label to reduce anemia? Good question; it does appear to help raise cell outs in myelodysplasia, but there are not even case reports out there to suggest utility in your situation, and the side effects, especially hypotension, are pretty frightening!
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Old 05-30-2009, 04:48 PM
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Thank you very much for your help.
I have another question (I think this is the last, I swear) if there is infiltration to the bone marrow, that means that other cell lines like monocytes and eosinophils should be reduced too, right? so if they are normal and the anemia is normocytic and hypochromic, could that mean that there is not infiltration to the bone marrow yet?
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Old 05-31-2009, 12:52 PM
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Thank you very much for your help.
I have another question (I think this is the last, I swear) if there is infiltration to the bone marrow, that means that other cell lines like monocytes and eosinophils should be reduced too, right? so if they are normal and the anemia is normocytic and hypochromic, could that mean that there is not infiltration to the bone marrow yet?
Good question. Chronic inflammation from say cancer, a smoldering auto-immune disease, or infection:
-- lowers red cells (and they stay normocytic but not hypochromic).
-- often raises platelet count
-- briefly raises white cell lines

Hypochromic anemia is most often from iron deficiency, but it is usually microcytic.

Bottom line: find out what your sed rate & CRP are. These measure inflammation. If high, work to get them down. See above. Also, find out what your serum iron (and folate, B12 while at it) are, and correct those with proper supplements if low.
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Old 05-31-2009, 01:06 PM
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Thank you very much!
But what does CRP stands for?
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Old 06-02-2009, 05:44 PM
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Thank you very much!
But what does CRP stands for?
CRP is short for c-reactive protein.
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Old 07-03-2009, 12:13 AM
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Have you tried making things more natural. How about exercise? You can also have a consultation for proper healing on this.
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Old 07-03-2009, 01:37 PM
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Thank you very much for your recomendations. The patient has reacted very favorably to the EPO and to an appropiate diet. His last Hb recount was of 14.5 g/dl and his PSA came as 2.4 ng/dl. The previous recount was of 338 ng/dl!
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