Is ADT causing anemia

wayneri, yes, testosterone deprivation lowers the body's production of erythropoietin (EPO), a hormone necessary for the production of rbcs. Ask your physician to prescribe EPO to bypass the need for testosterone.
Abiraterone can also lower blood sugar levels. Make sure they are testing you frequently. I'd want testing for iron, b12, blood sugar, and oxygen levels in addition to the CBC. Lower RBCs are common with ADT but are often mild. You might benefit from oxygen supplementation for now.
Sorry for your struggle. I think you'll get help.

Just having a low Red blood cell count won’t give you anemia. Mine’s always been low while on ADT. So has my hemoglobin and hematocrit, But my white blood cell count and platelets are fine.

If your counts are so low that you do have anemia, you can get blood transfusion. They do that for many people on PARP inhibitors.

You could ask for a palliative care doctor to help you with the fatigue problem. There are a number of drugs people are getting for fatigue. A drug like Ritalin can really make a difference.

I am so sorry to hear that : (((. My husband was anemic after RP surgery and he went to his primary care dr. and demanded B12 injection. His blood count improved immediately. B12 stimulates red blood cell production and is completely harmless. In Europe it is often given to patients for many other things and for some reason in the USA it is "unknown" option (?) . It is definitely worth trying since it can do zero harm !

I am sending you best wishes and healing vibes ✨🍀 and may your blood count improve in very near future. Keep us posted .

PS: Also, maybe you can try to switch to Estrogen patch as ADT form ? Perhaps estradiol does not cause anemia. And if not perhaps they can put you on Orgovix and Nubeqa - maybe those have less negative effect on blood count ?

Instead of remaining on ADT forever or having palliative care, is there any systemic or targeted therapy they can do to kill the lung lesion?

In this video by Dr. Johnson (of Mayo Clinic), he talks about a single prostate cancer lesion to a patient’s lung that showed up on a scan that they successfully surgically removed. Here’s the link to his presentation: https://youtu.be/JoJomACA5UM

The discussion about the prostate cancer lung lesion starts at about timestamp 24:55.

Low red blood cell levels cause anemic like symptoms because it is the red blood cells that carry oxygen to the muscles. Mine have been steadily falling since I took Lupron 17 months ago (took it for only 4 months). Besides the anemic feeling I got short of breath and aching muscles with any significant exercise level because my low blood cell count limited oxygen flow to my body. My doctor has started TRT and I am slowly getting my strength back. This might take a year or more as it took that long to lose the red blood cells.

@gently Thank you for your recommendations. I will forward your comments to my oncologist at the VA in Seattle. ~Wayne LeLoo 425.583.4177

@surftohealth88 You're right that B12 is important.

I started on B12 supplements (200 mcg/day) when we were eating a lot of vegan meals, due to a family member back living with us for a while. I'd never had to worry about B12 deficiency before as a vegetarian, because it's abundant in non-meat animal products like eggs and dairy, but there is no B12 in vegan or other 100% plant-based diet (unless added artificially, e.g. in nutritional yeast).

I know one vegan who was just dragging themself through every day until they started taking a B12 supplement. Things improved almost instantly.

It can and I did go anemic. Switched from Lupron to Orgovyx and it resolved itself within a 3 month period.