Estimated XXXX as a predictor of PSA recurrence after radical prostatectomy: results from the SEARCH database.

@entity190 @entity1 @entity5 @entity146
STUDY TYPE: Diagnosis (exploratory cohort). LEVEL OF EVIDENCE: 2b. OBJECTIVE: To clarify the relationship between estimated @entity190 (EBL) and biochemical recurrence, assessed by prostate-specific antigen (PSA) level, as @entity190 is a long-standing concern associated with radical prostatectomy (RP), and no studies to date have examined the association between @entity190 and @entity5 control. @entity1 AND METHODS: In all, 1077 @entity1 were identified in the Shared Equal-Access Regional @entity5 Hospital database who underwent retropubic RP (between 1998 and 2008) and had EBL and follow-up data available. We examined the relationship between EBL and recurrence using multivariate Cox regression analyses. RESULTS: Increased EBL was correlated with PSA recurrence in a multivariate-adjusted model (P = 0.01). When analysed by 500-mL EBL categories, those with an EBL of <1500 mL had a similar risk of recurrence. However, the risk of PSA recurrence tended to increase for an EBL of 1500-3499 mL, before decreasing again for @entity1 with an EBL of > or =3500 mL. @entity1 with an EBL of 2500-3499 mL had more than twice the risk of recurrence than @entity1 with an EBL of <1500 mL (P = 0.02). EBL was not associated with adverse @entity5 stage, grade or margin status. CONCLUSIONS: There was a significant correlation between EBL at the time of RP and biochemical recurrence. We hypothesized that this association might be due to transfusion-related immunosuppression, excessive blood obscuring the operative field, EBL being a marker of @entity146 , or EBL being a marker of poor surgical technique. However, our data did not completely fit any one of these hypotheses, and thus the ultimate cause for the increased risk of recurrence remains unclear and requires further study.
