What blood abnormalities are associated with prostate cancer?

From the Guidelines

If you have prostate cancer, the primary blood marker that may be elevated is Prostate-Specific Antigen (PSA), with a level above 4.0 ng/mL generally considered abnormal, as noted in studies such as 1. This is because PSA is a protein produced by cells within the prostate, and in men, PSA can be measured in the blood, as explained in 1. PSA levels tend to rise with prostate cancer progression, making it useful for monitoring treatment response and detecting recurrence. Other blood values that might be affected include:

• Alkaline phosphatase (ALP), which can be elevated if cancer has spread to the bones
• Complete blood count (CBC) may show anemia (low red blood cells) in advanced cases
• Liver function tests might be abnormal if the cancer has metastasized to the liver Additionally, doctors sometimes measure free PSA percentage (the ratio of unbound PSA to total PSA), as lower percentages can indicate a higher likelihood of cancer, as discussed in 1 and 1. It's essential to understand that blood tests alone cannot diagnose prostate cancer definitively - abnormal results require further investigation through imaging studies and possibly biopsy for confirmation, as emphasized in 1 and 1. Regular monitoring of these values is crucial for tracking disease progression and treatment effectiveness. Factors such as prostatitis, benign prostatic hyperplasia, urethral or prostatic trauma, and prostate cancer can all be associated with elevated serum PSA levels, as noted in 1. Therefore, consideration should be given to confirming an abnormal PSA before proceeding to biopsy, and laboratory variability should be taken into account when interpreting results, as highlighted in 1 and 1.

From the FDA Drug Label

Table 8. Laboratory Abnormalities XTANDI (N = 3526) Placebo (N = 2636) Grade 1-4 (%) Grade 3-4 (%) Grade 1-4 (%) Grade 3-4 (%) Hematology Hemoglobin decreased 50 1.8 47 1. 5 Neutrophil count decreased 20 1 17 0.5 White blood cell decreased 18 0.5 11 0.2 Chemistry Hyperglycemia 86 3.7 78 4.3 Hypermagnesemia 17 0.1 14 0.3 Hyponatremia 14 1.6 9 1.4 Hypophosphatemia 10 1.4 7 0.8 Hypercalcemia 8 0.1 5 0. 1

The blood numbers that will be off in patients with prostate cancer treated with enzalutamide include:

• Hemoglobin decreased: 50% of patients (Grade 1-4) and 1.8% (Grade 3-4) 2
• Neutrophil count decreased: 20% of patients (Grade 1-4) and 1% (Grade 3-4) 2
• White blood cell decreased: 18% of patients (Grade 1-4) and 0.5% (Grade 3-4) 2
• Hyperglycemia: 86% of patients (Grade 1-4) and 3.7% (Grade 3-4) 2
• Hypermagnesemia: 17% of patients (Grade 1-4) and 0.1% (Grade 3-4) 2
• Hyponatremia: 14% of patients (Grade 1-4) and 1.6% (Grade 3-4) 2
• Hypophosphatemia: 10% of patients (Grade 1-4) and 1.4% (Grade 3-4) 2
• Hypercalcemia: 8% of patients (Grade 1-4) and 0.1% (Grade 3-4) 2

From the Research

Prostate Cancer and Blood Test Results

If you have prostate cancer, several blood test results may be affected, including:

• Prostate-specific antigen (PSA) levels: PSA is a protein produced by the prostate gland, and elevated levels can indicate prostate cancer 3, 4, 5, 6, 7.
• Free PSA to total PSA (F/T) ratio: A low F/T ratio (<0.25) may indicate prostate cancer 6.
• Complexed PSA (cPSA) levels: cPSA has been shown to improve specificity in the detection of prostate cancer over total PSA testing in men with total PSA values greater than 4.0 ng/mL 7.

PSA Levels and Prostate Cancer

PSA levels can be affected by prostate cancer, and the following ranges may be associated with an increased risk of prostate cancer:

• PSA levels >10 ng/mL: This range is often associated with a higher risk of prostate cancer 3, 4.
• PSA levels >100 ng/mL: This range is highly predictive of bone metastases in patients with prostate cancer 4.
• PSA levels <4 ng/mL: While generally considered normal, some studies suggest that PSA levels in this range may still be associated with prostate cancer, particularly if the free PSA to total PSA ratio is low 6, 7.

Other Blood Test Results

Other blood test results may also be affected by prostate cancer, including:

• Alkaline phosphatase (ALP) levels: Elevated ALP levels can indicate bone metastases in patients with prostate cancer.
• Liver function tests: Prostate cancer that has metastasized to the liver may affect liver function test results.
• Complete blood count (CBC): Prostate cancer may affect the results of a CBC, particularly if the cancer has metastasized to the bone marrow.