Influence of blood transfusions during radical retropubic prostatectomy on disease outcome. 
Blood transfusion in patients with malignant neoplasms may alter the disease outcome because of a theoretical immunomodulatory effect.  This effect may reduce prostate-specific antigen (PSA)-free and disease-specific survival in patients with prostate cancer after radical prostatectomy.  However, the results in published studies have been contradictory, and this effect has not yet been determined.  We evaluated 1412 patients after radical prostatectomy from 1984 to 2003 in a retrospective analysis, with a special focus on the rate and type of blood transfusions, specifically heterologous versus autologous blood.  Univariate analysis and Cox regression analysis were performed to evaluate the impact of blood transfusions on disease outcome.  The overall transfusion rate was 56.7%.  The rate dropped from 88.9% in 1988 to 9.1% in 2002.  PSA recurrence (greater than 0.5 ng/mL) was noted in 11.0% in patients without and in 26.0% with blood transfusions, which was not statistically significant on Kaplan-Meier analysis.  Again, no difference was noted when patients were stratified according to the type (autologous versus heterologous) or the amount (2 U or less versus more than 2 U) of blood transfusion.  Evaluating overall survival, again no differences were found.  The established Cox regression model also proved that blood transfusions had no impact on disease outcome.  Our retrospective analysis did not detect any effect of blood transfusions in patients with prostate cancer after radical prostatectomy.  If a negative adverse effect occurs, this effect must be minimal.  However, the infectious risk and the costs of blood transfusions should be reason enough to reduce blood loss and the transfusion rate further in patients with prostate cancer.