The role of preoperative epoetin alfa in men undergoing radical retropubicprostatectomy

Purpose: The safety and effects on hematocrit of recombinant human erythrop oietin (epoetin alfa) were evaluated in men undergoing radical retropubic p rostatectomy. Materials and Methods: Between February 1, 1997 and November 2, 1998, 305 m en with clinically localized adenocarcinoma of the prostate underwent radic al retropubic prostatectomy performed by a single surgeon (H. L.). Of these men 283 with a baseline hematocrit of less than 48% received 600 IU/kg. ep oetin alfa 14 days (-14) and 7 days (-7) before radical retropubic prostate ctomy. Hematocrit was measured at baseline on day -14, on day -7, just befo re anesthesia induction on day 0, immediately postoperatively and on the da y of discharge home. The number of allogeneic units transfused, and all int raoperative and postoperative complications were recorded, Results: Mean hematocrit at baseline on day -14 and at induction on day 0 w as 42.9% and 45.8%, respectively (p = 0.0001). The frequency of hematocrit decreasing, showing no change or increasing 0.1 to 1.9, 2.0 to 3.9 or great er than 4.0 hematocrit points was 16.5%, 0.5%, 23%, 22% and 38%, respective ly. Of the men 17% had no increase in hematocrit, A weak correlation existe d between baseline hematocrit and the erythropoietic response to epoetin al fa (r(2) = 0.06). Mean change in hematocrit after treatment with epoetin al fa in the quartile baseline hematocrit groups 34.2 to 41.4, 41.5 to 43.2, 4 3.3 to 44.9 and 45.0 to 48.0 hematocrit points was 3.71, 2.45, 3.86 and 1.0 2 hematocrit points, respectively. Of the surgical candidates 22 (9.1%) ach ieved an induction hematocrit of greater than 51%. Of the 283 men receiving epoetin alfa 21 (7.4%) also received an allogeneic transfusion. The transf usion rate did not correlate with induction hematocrit. The only adverse ca rdiovascular event was an uncomplicated postoperative pulmonary embolus. Conclusions: Our prospective study demonstrates that epoetin alfa given pre operatively in 2 doses of 600 IU/kg. is safe for significantly increasing h ematocrit in men before radical retropubic prostatectomy. It is intuitive t hat the significant increase in hematocrit decreases the requirement for al logeneic blood transfusion.