title: Factors associated with blood loss during radical prostatectomy for localized prostate cancer in the prostate-specific antigen (PSA)-era: an overview of the Department of Defense (DOD) Center for Prostate Disease Research (CPDR) national database.
abstract: Radical Prostatectomy (RP) has been traditionally associated with significant operative blood loss and high risk of transfusion. However, over the last few years, centers of excellence have reported less bleeding and transfusion. To verify and document changes in the epidemiology of bleeding and transfusion of men electing RP, we undertook an analysis of such cases in the Department of Defense (DoD) Center for Prostate Disease Research (CPDR) Multicenter Research Database. Using the Department of Defense Center for Prostate Disease Research (CPDR) Multicenter National Research Database, a query of all RPs performed between January 1, 1985 and December 31, 2000 was conducted revealing 2918 cases with blood-loss data available for analysis from nine hospital sites. These cases were analyzed over time (calendar year) and changes in the characteristics of the patients, disease severity, and surgical results were compared with estimated blood loss (EBL) and transfusion data. Among the 2918 evaluable men, 2399 (82%) underwent a retropubic RP, 97% had clinical T1-2 disease, and 77% had a PSA level > or =10.0 ng/mL. Overall median operation time was 3.8 h, and EBL was 1000 cc. Examining trends over time, there was a dramatic decline in median operative time, EBL, and transfusion rate. In multiple linear regression analysis, operative time, operative approach, surgery year, lymphadenectomy status, and neoadjuvant hormonal therapy were significant predictor of EBL. Blood loss difference between retropubic and perineal RP became insignificant in the latter years. Radical prostatectomy is being performed more commonly on men with earlier stage disease in the PSA-Era. The operation is now performed more rapidly with less blood loss and fewer transfusion requirements. In a broad practice experience represented here, autologous blood donation would appear to be unnecessary for the majority of men and the blood loss advantage traditionally associated with perineal RP is no longer evident.
authors.affiliation: Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. JMOUL@CPDR.ORG
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Hongyu
authors.initials: H
authors.lastname: Wu
authors.forename: David G
authors.initials: DG
authors.lastname: McLeod
authors.forename: Christopher
authors.initials: C
authors.lastname: Amling
authors.forename: Raymond
authors.initials: R
authors.lastname: Lance
authors.forename: John
authors.initials: J
authors.lastname: Foley
authors.forename: Wade
authors.initials: W
authors.lastname: Sexton
authors.forename: Leo
authors.initials: L
authors.lastname: Kusuda
authors.forename: Andrew
authors.initials: A
authors.lastname: Chung
authors.forename: Douglas
authors.initials: D
authors.lastname: Soderdahl
authors.forename: Timothy
authors.initials: T
authors.lastname: Donahue
mesh_terms: D000368:Aged; D035843:Biomedical Research; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D037041:United States Government Agencies
chemical_list: D017430:Prostate-Specific Antigen