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What Type Of Anemia Is Associated With Prostate Cancer

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Can Cancer Or Cancer Treatment Cause Anemia

Neutropenia, Anemia, Thrombocytopenia – Medical-Surgical (Immune) | @LevelUpRN

Cancer and some cancer treatments can cause anemia, but there are many other reasons someone may be anemic. Not everyone with cancer has anemia or will develop it. In fact, anemia is more likely to be caused by other factors than cancer, say specialists.

Cancers that involve the bone marrow, like leukemia or lymphoma, can cause anemia because red blood cells are produced in the marrow. Some cancers can metastasize to the bone marrow, such as breast and prostate cancer, and if this happens can also interfere with red blood cell production and cause anemia. Cancers that are prone to cause bleeding, like colon and stomach cancer, are also potential causes of anemia due to blood loss. Cancers also cause inflammation, which suppresses the bone marrow and can lead to anemia.

Both chemotherapy and radiation treatment for cancer can cause anemia, because these modalities attack fast-growing cells, including red blood cells. Sometimes anemia develops during cancer treatment because the person isnt getting enough vitamins and minerals in their diet.

Treatments for cancer-associated anemia depend on the cause of anemia. Common treatments include giving drugs that increase red blood cell production or supplementing red blood cell levels with transfusions. If a patient has anemia due to iron deficiency, anemia can be treated by increasing iron through supplements, dietary changes, and sometimes intravenous administration of iron.

When Is Radiation Therapy Used As Adjuvant Treatment

Adjuvant therapy is an additional cancer treatment that is given after the primary treatment. Adjuvant therapy lowers the risk that the cancer comes back. Primary treatment for skin cancer is often surgery, with radiation therapy as an adjuvant therapy. Radiation kills cancer cells left after the skin cancer was removed.2 This is recommended for:

  • BCC, SCC, or melanoma that grew into a nerve.6,8,9
  • Non-melanoma skin cancer when cancer cells are found on the edges of the sample despite Mohs surgery.
  • Deep desmoplastic melanoma, a type of melanoma that is likely to recur.6
  • Melanoma that recurs.6

Adjuvant radiation therapy is also recommend after lymph node removal.4,6 Without radiation therapy, about 40% of high-risk individuals have recurrent melanoma in the remaining lymph nodes.10 With adjuvant radiation therapy, about 10% of people have lymph node cancer recurrence.10

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Why Is Anemia Linked To Cancer

While there are several types of anemia, iron deficiency anemia is the type that is most often linked to cancer. Iron deficiency anemia is caused by a lack of healthy red blood cells in the body.

There are several cancers that can attack blood cells, causing anemia. Chemotherapy cancer treatment can also cause anemia by slowing down the production of new blood cells.

Ultimately, researchers

is caused by a lack of a sufficient amount of the mineral iron to make healthy red blood cells. Your body makes red blood cells in bone marrow, a spongy material inside your bodys largest bones.

Red blood cells carry oxygen from the lungs to the rest of your body. A low red blood cell count or anemia occurs when:

  • the body does not make enough
  • red blood cells are lost through bleeding
  • the body starts to destroy its own red blood cells

When red blood cells are damaged or not numerous enough, they cannot carry oxygen efficiently throughout your body. This leads to symptoms including weakness and fatigue. Anemia can cause serious health complications if left untreated.

Iron deficiency anemia is

People most at risk for anemia include older adults, people who menstruate, people with alcohol use disorder, and those who experience neglect, or those who are unable to access enough nutrients.

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Health And Social Care Professionals You Might See

You might see a range of different professionals to help manage your symptoms and offer emotional and practical support. Some may have been treating you since your diagnosis. Others provide specific services or specialise in providing treatment to manage symptoms .

If you have questions or concerns at any time, speak to someone in your medical team. They can explain your diagnosis, treatment and side effects, listen to your concerns, and help you get support.

Blood Transfusions To Treat Anemia

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A blood cell transfusion is a safe and a common way to treat anemia in people with cancer. It can help the patient feel better and helps oxygen get to vital organs. While blood transfusions can help symptoms very quickly, sometimes the relief is temporary depending on the cause of anemia.

Whether a blood transfusion might be needed depends on how severe your symptoms are and your hemoglobin level. A transfusion might be done if your hemoglobin level reaches a certain number or if your symptoms get too bothersome

A blood transfusion requires careful matching of donated blood to the recipients blood. Blood products are tested to be sure they are safe and the same kind of blood type as the recipient. But, receiving a blood transfusion also has some risks

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Metastatic Spinal Cord Compression

Metastatic spinal cord compression happens when cancer cells that have spread from the prostate grow in or near to the spine, and press on the spinal cord. MSCC isnt common, but you need to be aware of the risk if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. The risk of MSCC is highest if the cancer has already spread to the spine. Speak to your doctor or nurse for more information about your risk.

MSCC can cause any of the following symptoms.

  • Pain or soreness in your lower, middle or upper back or neck. The pain may be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, go to the toilet, or lie down. It might get worse when you are lying down. It may wake you at night or stop you from sleeping.
  • A narrow band of pain around your abdomen or chest that can move towards your lower back, buttocks or legs.
  • Pain that moves down your arms or legs.
  • Weakness or loss of control of your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
  • Numbness or tingling in your legs, arms, fingers, toes, buttocks, stomach area or chest, that doesnt go away.
  • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

Dont wait

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Iron Export In Pca Cells

Ferroportin is the only known cellular iron exporter. In many cancers its activity is downregulated, which increases iron pool in cancer cells . Similarly, FPN dowregulation has also been observed in PCa . By stimulating FPN activity we can curb the growth and proliferation of PCa . This occurs due to cellular iron deprivation caused by increased activity of FPN. Furthermore, consistent FPN overexpression overrules compensatory mechanisms used by PCa cells to replete iron depots via increase in iron import . More importantly, FPN overexpression reduces tumor proliferation in different types of PCa’s, and irrespective of androgen sensitivity .

Table 1. Expression, regulation and effects of iron-related proteins in prostate cancer cells*.

Another field of study with many unanswered questions is the relation of mitochondrial iron metabolism with PCa pathogenesis. The gene responsible for coding mitoferrin, which is a mitochondrial iron transporter, is upregulated in PCa patients, but the importance of mitoferrin in PCa cells has still not been elucidated despite its proposed role in cancer .

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Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

  • Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. Its usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
  • Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
  • Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
  • Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction:

Common Types Of Iron Deficiency In Cancer

Reducing Side Effects of Hormone Therapy for Prostate Cancer | Prostate Cancer Staging Guide

Two main forms of iron deficiency are seen in people with cancer: absolute and functional.

In absolute iron deficiency, the body lacks an adequate supply of iron. According to a study published in December 2015 in the Central European Journal of Medicine, absolute iron deficiency is usually caused by blood loss, poor iron absorption, or both. Because of this, colorectal cancer carries an especially high risk of absolute iron deficiency, but other cancers carry risks as well.

In functional iron deficiency, the body has adequate iron stores mostly in the blood, liver, spleen, and bone marrow but for various reasons related to biochemistry, it cant adequately use this iron. Common causes of functional iron deficiency include inflammation which may be caused by cancer, infection, chronic kidney disease, or other chronic diseases as well as certain drugs or nutritional deficiencies, such as a copper deficiency.

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Associations Between Hematologic Data And Prostate Cancer Incidence And Mortality

Estimates are corrected for regression dilution bias uncorrected results are displayed in Supplementary Table S2.

Higher total red blood cell count was associated with an elevated risk of prostate cancer . Higher MCV , MCH , MCHC , and MSCV were associated with a lower prostate cancer risk . Red blood cell indices were not associated with prostate cancer mortality .

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Treatment To Lower Androgen Levels From Other Parts Of The Body

LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.

Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.

Abiraterone can be used in men with advanced prostate cancer that is either:

  • Castration-resistant

This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.

Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.

Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .

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Treatment Of The Underlying Cause

The treatment of anemia will depend on the underlying cause, which as noted, can be a number of different things. For chemotherapy-induced anemia, your next infusion may need to be canceled or delayed until your counts have increased.

If your cancer has invaded your bone marrow, treatment addressing cancer in your bone marrow will be the first step.

Side Effects Induced By Endocrine Therapy

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Endocrine therapy, one of the comprehensive treatment ofpatients with prostate cancer, may leading to anemia as a commoncomplication. Endocrine therapy functioned as an antagonist toserum testosterone, as castrated by androgen-blocking drugs. Sincetestosterone is the most important androgen in men, the lack oftestosterone may cause a decrease in the level of erythropoietin,leading to a descending in serum red blood cell count and hemoglobinlevels. In this case, the low hemoglobin level occurred much earlierthan the patients endocrine therapy.

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Treating Pca By Modulating Iron Metabolism

The strategy to treat PCa by modulating tumor iron metabolism has already been subject of research. Iron chelators, first introduced in the 1960s, have been tested as anticancer drugs for 30 years . In PCa, the use of experimental treatment with iron chelators goes back to 1995. In the study done by Kovar et al. deferoxamine reduced tumor growth by 35 and 38%, respectively, depending on the tumor cell lines used . DFO efficacy was increased with co-treatment with anti-TFR antibodies. Soon after, first human trial was realized with a small number of patients suffering from hormone-refractory PCa . The use of DFO for 8 h did not yield any significant results in disease control. DFO failure in human trials occurred probably due to the drugs difficulty penetrating and accumulating in PCa cells when used in a systemic form . Deferiprone is another iron-chelator that has been used to treat PCa in cultured medium. It has shown antitumor activity in different PCa cell lines, by influencing tumor energy production, cell migration and tumor volume, but these results have not been validated in human trials with PCa patients . Newer iron chelators have also shown antitumor properties but they have been only tested in cultured cells . It has to be mentioned that iron chelation has its drawbacks, such as toxicity, patient compliance, induction of reactive increase in iron import proteins, lower efficacy with higher density of iron laded TAMs in tumors .

Further Treatments To Control The Cancer

Your first treatment may help keep your cancer under control. But over time, the cancer may change and start to grow again. If this happens you might be offered other treatments, including:

  • more hormone therapy
  • clinical trials

More hormone therapy

Your prostate cancer may respond well to other types of hormone therapy, such as abiraterone , enzalutamide , steroids or oestrogens, or to a combination of treatments.

More chemotherapy

If youve had hormone therapy on its own as a first treatment, you might be offered a chemotherapy drug called docetaxel . This may help some men to live longer, and can help to improve and delay symptoms. If youve already had docetaxel, you might be offered more docetaxel or another chemotherapy drug called cabazitaxel .

Radium-223

This is a type of internal radiotherapy that may be an option if your cancer has spread to your bones and is causing pain. A radioactive liquid is injected into your arm and collects in bones that have been damaged by the cancer. It kills cancer cells in the bones and helps some men to live longer. It can also help to reduce bone pain and delay some symptoms, such as bone fractures. Read more about radiotherapy for advanced prostate cancer.

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Early Versus Delayed Treatment

For men who need hormone therapy, such as men whose PSA levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when it is best to start hormone treatment. Some doctors think that hormone therapy works better if its started as soon as possible, even if a man feels well and is not having any symptoms. Some studies have shown that hormone treatment may slow the disease down and perhaps even help men live longer.

But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the side effects of hormone therapy and the chance that the cancer could become resistant to therapy sooner, treatment shouldnt be started until a man has symptoms from the cancer. This issue is being studied.

Causes Of Anemia Related To Cancer

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

Causes of anemia that are related to cancer include:

  • Bone marrow replacement: Some cancers, such as lymphomas or metastases from breast cancer can invade the bone marrow and replace the bone marrow cells which make red blood cells.
  • Chemotherapy: Chemotherapy can induce anemia.
  • Cytokines: High levels of cytokines related to some cancers can slow the production of red blood cells by the bone marrow.
  • Change in diet: Cancer itself can cause a poor appetite which can result in nutritional deficiencies leading to anemia. In addition to affecting the bone marrow, chemotherapy can cause symptoms such as mouth sores, taste changes, and loss of appetite that can lead to anemia.
  • Hemolytic anemia: This can occur in people without cancer but is particularly common in people with lymphomas.

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