My father, aged 83, has downtrending 150k since four years ago, recently 100k. He has macrocytic anemia since Feb 2015, after his first injection of androgen deprivation therapy (ADT) for his prostate cancer in mid Dec 2014. His pre-ADT Hgb in Nov 2014 is 14.5 but dropped to 9.5 in mid Feb 2015. Because of this anemia issue, we stopped his ADT and Hgb then improved slightly to 10+. His radiation therapy (RT) for prostate cancer is held up for the time being for investigation of his anemia problem. Other tests for anemia e.g. serum B12, folate, lactate dehydrogenase (LDH) are normal. But he has hypersegmented WBC. He also has high MCV (rang from 103 – 107 since mid Feb 2015). His creatinine level has always been high and is about 180+ currently. Doctor said that impaired renal function can cause anemia. But his Hgb has always been within normal range despite high creatinine, and I wonder why suddenly there is such a sharp drop after first shot of ADT. My questions are - 1.     Could it be the side effect of ADT causing his sharp drop of Hgb from 14.5 to 9.5? 2.     Because of his high MCV and hypersegmented WBC, we worry that he may have bone marrow disorder like MDS. Is it possible that ADT could trigger bone marrow problems? 3.     Our doctor (internal medicine) did not suggest bone marrow biopsy as he said even if my father has MDS or other bone marrow disease, he cannot tolerate the treatments and hence not much can be done. On the other hand, the oncologist said that his PCa needs to be treated, and we can choose RT for curative purpose or just ADT in view of his medical history (hypertension, renal impairment, pAF, dementia, gout). We on the one hand worry that RT may have suppression on his bone marrow or trigger bone marrow disorder and on the other hand worry about the side effects of continued ADT. Is intermittent ADT a possible approach? His latest PSA in mid Apr 2015 (after one shot of ADT) is 0.02. Any advice and insight would be helpful to us. Thanks a lot Ms Leung