RED BLOOD CELL DISTRIBUTION WIDTH: A NEW POSSIBLE LABORATORY PARAMETER IN THE MANAGEMENT OF PROSTATE CANCER

• Published in: Anticancer research Vol. 38; no. 4; p. 2590
• Main Authors: Durante, Jacopo, Bracchitta, Damiano, Tognarelli, Alessio, Di Vico, Tommaso, Polito, Chiara, Meneghetti, Iacopo, Tesi, Lorenzo, Baldesi, Ramona, Ponchietti, Roberto
• Format: Journal Article
• Language: English
• Published: Athens International Institute of Anticancer Research 01.04.2018
• Subjects: Adenocarcinoma; Age; Anemia; Atrophy; Biochemistry; Biopsy; Blood glucose; Blood tests; Cancer; Cancer surgery; Cardiovascular diseases; Cholesterol; Colon; Diagnosis; Disease; Erythrocytes; Hematocrit; Hematological diseases; Hematology; Hemoglobin; High density lipoprotein; Hyperplasia; Illnesses; Infectious diseases; Leukocytes; Low density lipoprotein; Medical treatment; Nutritional status; Pancreas; Parameters; Patients; Population (statistical); Population studies; Prostate cancer; Prostatectomy; Radiation therapy; Statistical analysis; Statistical significance; Surgery; Thyroid; Triglycerides; Urological surgery
• ISSN: 0250-7005; 1791-7530

Background/Aim: The RDW (Red blood cell Distribution Width) is a simple parameter of the standard complete blood count, which evaluates the variation in cellular volume of the erythrocyte population. Several studies published in recent years have correlated RDW to patients’ outcomes in cardiovascular disease and sepsis. More recently, we have also tried to evaluate this parameter in the field of malignant neoplastic diseases (thyroid, colon and pancreas). Scientific literature seems to be oriented, both in cardiovascular and infectious diseases, to relate higher values of RDW with a worse outcome or with more advanced stages of illness. The aim of this study is to evaluate RDW in patients with prostatic disease as a possible useful parameter for the diagnosis and follow-up of prostate carcinoma. Materials and Methods: The study considered 178 patients divided into four groups depending on histological diagnosis obtained with prostate biopsy: 23 patients with benign prostatic hyperplasia (BPH), 9 with granulomatous flogosis, 28 with Prostatic Intraepithelial Neoplasia - PIN (only high grade PINs were inserted in the study) and 97 with prostate adenocarcinoma. A fifth group included 21 patients who underwent a surgical or radiotherapy prostate cancer treatment and then developed a biochemical disease recurrence (BCR - defined as total PSA ≥0.20 ng/ml). In patients with glandular atrophy, PIN and granulomatous prostatitis, the closest complete blood count to the biopsy (within a period of 3 months before or after the biopsy) was evaluated. In patients with prostate cancer (confirmed on specimen after radical prostatectomy) the pre- operative complete blood count was considered. In patients with BCR, the first post-diagnosis blood count was evaluated, but always prior to a new therapeutic treatment. Patients affected by anemia and other hematological diseases were excluded from the study. For each patient, blood count parameters (white blood cells, red blood cells, hemoglobin, hematocrit, MCV and RDW), glycaemia, albumin, triglycerides, total cholesterol, HDL and LDL, and PSA were evaluated. Patients with glandular atrophy were defined as “healthy patients” and considered as the control group. Binary associations were then performed between the different categories in which the patients of the study were classified. Since RDW depends on patient’s nutritional status, age and age-related illnesses, it was necessary to obtain as uniform as possible groups. Particularly for age, we encountered some objective difficulties in obtaining a homogeneous sample in patients with prostatitis, glandular atrophy, HGPIN, adenocarcinoma and BCR. Results: Regarding the difference between the adenocarcinoma group and the BPH group, the value of RDW is higher in malignant disease and is statistically significant (p=0.001). A statistical significance was also found between the BCR group and the atrophy group (p=0.001), with higher levels of RDW in the former. Significantly higher RDW values were also found in prostatitis than atrophy (p=0.001), where there is also a higher value of leukocytes concentration (p=0.017). Unfortunately, however, the specificity of the RDW does not seem particularly elevated. We could not demonstrate a significant difference in RDW between the prostatitis group and the adenocarcinoma group. There was no difference even between adenocarcinomas group and the BCR group. Conclusion: In the investigated sample, RDW seems to correlate with neoplastic disease and inflammatory prostatic conditions. BPH, on the other hand, is associated with inferior RDW values. The highest RDW values were observed in patients with biochemical recurrence. In addition, the RDW seems to correlate with phlogosis and neoplastic proliferation more significantly than other blood count parameter. The lack of a statistical significant difference between cancer and biochemical disease recurrence groups may be related to the fact that at the time of the blood sample, both patients with cancer and patients with biochemical disease recurrence had to be considered ill. If the RDW value in patients undergone to radical prostatectomy had been considered at least 120 days (average life of a red blood cell) after the surgery, a significant difference could have been observed.