Predictors of hemoglobin decline in non-metastatic prostate cancer patients on androgen deprivation therapy: a matched cohort study

Abstract

The extent and severity of hemoglobin decline after the initiation of androgen deprivation therapy (ADT) is unclear, and predictors of hemoglobin decline in older men with prostate cancer (PC) are not well-characterized. Three cohorts were recruited in this prospective study to evaluate the impact of ADT and other factors on hemoglobin decline. Cohorts included ADT users initiating continuous ADT, PC controls, and healthy controls, matched on age and education. All patients with PC had non-metastatic disease. Univariate and multivariable associations between changes in hemoglobin over 12 months and baseline characteristics were evaluated using linear regression models. We included 250 men (mean age 69 years). The baseline mean hemoglobin was 141 g/L in ADT users, 144 g/L in PC controls, and 149 g/L in healthy controls (p < 0.001). Over 12 months, the mean hemoglobin level declined in ADT users by 8.9 g/L, compared to 0.56 and 2.03 g/L among PC controls and healthy controls, respectively (p < 0.001). Statistically significant predictors of greater hemoglobin decline included ADT use (p < 0.001), lower activities of daily living score (p < 0.001), higher Charlson comorbidity score (p = 0.02), higher baseline hemoglobin level (p < 0.001), and non-White race (p = 0.04) but not age (p = 0.50). In men with non-metastatic prostate cancer, ADT was independently associated with a decline in hemoglobin level over 12 months. Other predictors of declining hemoglobin included comorbidity, functional status, baseline hemoglobin level, and race. These findings may help clinicians identify patients starting ADT who would benefit from closer hemoglobin monitoring.