Characterization of perioperative leukocytosis in patients undergoing robot-assisted radical prostatectomy: Effects of gleason score and race

Introduction: Our objective was to determine the impact of race and tumor grade on perioperative leukocytosis on patients undergoing robot-assisted radical prostatectomy (RARP). Methods: A retrospective review of our urologic oncology database for patients undergoing RARP from August 2002 to July 2011 was conducted. A total of 768 patients were identified with complete data. Demographic data, preoperative prostate specific antigen (PSA), biopsy Gleason score, pathology Gleason score, pathology stage, margin status, and node status were collected. White blood cell (WBC) counts were captured preoperatively, 1 hour postoperatively, and on postoperative day 1. We assessed the differences in leukocyte responses according to the race and Gleason score using ANOVA testing. Results: Preoperative WBC was lowest in black men and comparable between white and Hispanic men. At 1 hour, postoperative WBC remained lowest in Black men (p<0.001). Post-RARP leukocytosis varied significantly depending on the race (p<0.001). At 1 hour, patients with Gleason 8-10 tumors had decreased WBC compared to Gleason 6 patients (p<0.05) despite similar preoperative WBC and Charlson comorbidity index values. Conclusions: We report novel clinical observations that suggest differences in the immune response associated with the race and Gleason grade following RARP. The clinical utility of these findings are yet to be determined.