Effect of perioperative blood transfusion on prostate cancer recurrence

Background: Transfusion may predispose patients to an increased risk of tumor recurrence following solid organ surgery. Lung and colon cancer studies suggest that blood transfusions promote tumor growth or distant metastasis possibly due to immunosuppression. Blood loss can be high during radical retropubic prostatectomy necessitating intraoperative and postoperative blood transfusion. The impact of blood transfusion on recurrence risk after radical retropubic prostatectomy remains uncertain. Objective: To determine the influence of allogeneic or autologous blood transfusion on prostate cancer recurrence in men undergoing radical retropubic prostatectomy and assess their prognostic significance using serum prostate-specific antigen (PSA) as an intermediate endpoint. Methods: Six hundred eleven men treated from 1987 to the present have had all clinical and follow-up data entered prospectively into a clinical database; 242 (40%) did not receive blood transfusion, 252 (41%) received autologous blood transfusion, and 117 (19%) received allogeneic blood transfusion. Biochemical failure was defined as PSA > 0.3 ng/ml on any follow-up visit. ANOVA, chi-square, and survival analyses were used to evaluate clinical characteristics and biochemical progression-free survival. Results: Patients participated for a mean of 44 months, range 1 to 170 months, until biochemical progression (78) or July 1, 2005 (533). Average estimated blood loss was 929 ml, 1573 ml, and 2,818 ml in the no blood transfusion, autologous blood transfusion, and allogeneic blood transfusion groups, respectively (P = 0.001). Patients in the allogeneic transfusion group were older, had higher preoperative PSA, higher stage disease, and greater blood loss. Biochemical failure rates were similar in the 3 groups (P = 0.42). Biochemical failure at 5 years occurred in 14% of men who did not receive blood transfusion, 10% of men who received autologous blood transfusion, and 16% of men who received allogeneic blood transfusion. No patient suffered clinical progression or prostate cancer death. Conclusions: Autologous or allogeneic blood transfusions do not appear to influence the risk of biochemical failure in men with clinically localized prostate cancer treated with radical retropubic prostatectomy.