The short‐term use of erythropoetin‐stimulating agents: impact on the biochemical recurrence of prostate cancer

Abstract

Study Type – Harm (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Erythropoletin‐stimulating agents (ESAs) have been widely prescribed for treating anaemia secondary to advanced maligancies with the objective of reducing the need for red blood cell transfusions and improving the quality of life. However, the risk/benefit of ESAs has recently been questioned and metaanalyses showing that these agents are associated with an increased risk of mortality when chronically administered to patients with advanced/metastatic cancers. In this study we examined the impact of short‐term preoperative utilization of ESAs on biochemical recurrence – free survival rates after open radical retropubic prostatectomy (ORRP). OBJECTIVE To examine the impact of short‐term preoperative utilization of erythropoietin‐stimulating agents (ESAs) on biochemical recurrence (BCR)‐free survival rates after open radical retropubic prostatectomy (ORRP) in light of the fact that the risk/benefit of ESAs has recently been questioned by the Food and Drug Administration (FDA) after reports showing a decreased survival. PATIENTS AND METHODS From 2000 to 2008, 1567 patients underwent ORRP and 97.5% of these signed informed consent to participate in the New York University Prospective and Longitudinal Outcomes Study. Of the remaining 1528 patients, 1317 (86%) received preoperative ESA (group 1) and 211 (14%) did not (group 2). Patients were also classified as having low‐, intermediate‐ or high‐risk disease based on D’Amico risk categories. Kaplan–Meier survival curves and Cox’s proportional hazard models were used to estimate BCR‐free survival by ESA treatment. RESULTS A significant difference was observed for BCR‐free survival between the low‐ and intermediate/high‐risk groups. There were no statistically significant differences between groups 1 and 2 for BCR‐free survival in the entire study populations and within risk groups. In addition, Cox regression models showed no statistically significant differences in BCR‐free survival according to preoperative ESA administration in the entire cohort as well as among the low‐ and intermediate/high‐risk groups. CONCLUSIONS The short‐term use of ESAs as a preoperative blood management strategy for patients undergoing ORRP has no clinically relevant adverse effects on the biology of prostate cancer. The present study supports the use of these agents before the procedure in patients undergoing surgery for localized disease.

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