Red Cell Distribution Width as a Predictor of Prostate Cancer Progression

  • Albayrak, Sebahattin (Department of Urology, School of Medicine, Bozok University) ;
  • Zengin, Kursad (Department of Urology, School of Medicine, Bozok University) ;
  • Tanik, Serhat (Department of Urology, School of Medicine, Bozok University) ;
  • Bakirtas, Hasan (Department of Urology, School of Medicine, Bozok University) ;
  • Imamoglu, Abdurrahim (Department of Urology, School of Medicine, Bozok University) ;
  • Gurdal, Mesut (Department of Urology, School of Medicine, Bozok University)
  • Published : 2014.10.11


Background: The aims of this study were to investigate the utility of red blood cell distribution width (RDW) as a simple and readily available marker in prostate cancer, as well as to evaluate RDW as a predictor of progression in prostate cancer patients. Materials and Methods: We evaluated 62 newly diagnosed prostate cancer patients who underwent transrectal ultrasound (TRUS)-guided biopsy and 62 healthy controls of mean age 64 (range, 45-75) years at the Urology Clinic of Bozok University Hospital. Data collection was performed using our laboratory information system database to retrieve findings regarding RDW, hemoglobin, prostatespecific antigen (PSA), and age. The RDW values were compared between the healthy control group and prostate cancer patients. A high risk of progression as defined as a Gleason score (GS) >6, total number of cores positive for cancer >33%, each core containing >50% cancer cells, and a prostate-specific antigen (PSA) level >10 ng/mL. Patients were classified according to risk of progression, as well as divided into subgroups according to the RDW quartile. Results: The mean RDW value of prostate cancer patients was 14.6, compared with 13.7 in the healthy control group (p=0.001). A higher RDW was associated with an increased risk of progression, whereas a lower RDW value was correlated with a low risk of progression. Conclusions: RDW is an easily derived measure that might, in combination with other markers, help predict prostate cancer risk and progression. We suggest that RDW may be used in combination with other parameters in the assessment of prostate cancer.


  1. Celikbilek A, Zararsiz G, Atalay T, et al (2013). Red cell distribution width in migraine. Int J Lab Hematol, 35, 620-8.
  2. Beer TM, Lalani AS, Lee S, et al (2008). C-reactive protein as a prognostic marker for men with androgen-independent prostate cancer: results from the ASCENT trial. Cancer, 112, 2377-83.
  3. Borre M, Nerstrom B, Overgaard J (1997). Erythrocyte sedimentation rate-a predictor of malignant potential in early prostate cancer. Acta Oncol, 36, 689-94.
  4. Cakal B, Akoz AG, Ustundag Y, et al (2009). Red cell distribution width for assessment of activity of inflammatory bowel disease. Digestive Diseases and Sciences, 54, 842-7.
  5. Cihan YB, Arslan A, Ergul MA (2013). Subtypes of white blood cells in patients with prostate cancer or benign prostatic hyperplasia and healthy individuals. Asian Pac J Cancer Prev, 14, 4779-83.
  6. Cheng I, Witte JS, Jacobsen SJ, et al (2010). Prostatitis, sexually transmitted diseases, and prostate cancer: the California men's health study. PLoS One, 5, 8736.
  7. Cho H, Hur HW, Kim SW, et al (2009). Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother, 58, 15-23.
  8. Cho H, Kim JH (2009). Multiplication of neutrophil and monocyte counts (MNM) as an easily obtainable tumour marker for cervical cancer. Biomarkers, 14, 161-70.
  9. Dennis LK, Dawson DV (2002). Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology, 13, 72-9.
  10. Emerging Risk Factors C, Kaptoge S, Di Angelantonio E, et al (2010). C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet, 375, 132-40.
  11. Felker GM, Allen LA, Pocock SJ, et al (2007). Red cell distribution width as a novel prognostic marker in heart failuredata from the charm program and the duke databank. J Am College Cardiol, 50, 40-7.
  12. Ferronika P, Triningsih FX, Ghozali A, et al (2012). p63 cytoplasmic aberrance is associated with high prostate cancer stem cell expression. Asian Pac J Cancer Prev, 13, 1943-8.
  13. Fujita K, Imamura R, Tanigawa G, et al (2012). Low serum neutrophil count predicts a positive prostate biopsy. Prostate Cancer Prostatic Dis, 15, 386-90.
  14. Kazma R, Mefford JA, Cheng I, et al (2012). Association of the Innate Immunity and Inflammation Pathway with Advanced Prostate Cancer Risk. Plos One, 7.
  15. Godsland IF, North BV, Johnston DG (2011). Simple indices of inflammation as predictors of death from cancer or cardiovascular disease in a prospective cohort after two decades of follow-up. Qjm-an Int J Med, 104, 387-94.
  16. Henry-Amar M, Friedman S, Hayat M, et al (1991). Erythrocyte sedimentation rate predicts early relapse and survival in early-stage Hodgkin disease. The EORTC Lymphoma Cooperative Group. Ann Intern Med, 114, 361-5.
  17. Japanese Urological Association (2010). Committee for Establishment of the Guidelines on Screening for Prostate Cancer1; Updated Japanese urological association guidelines on prostate-specific antigen-based screening for prostate cancer in 2010. Int J Urol, 17, 830-8.
  18. Klink JC, Banez LL, Gerber L, et al (2013). Intratumoral inflammation is associated with more aggressive prostate cancer. World J Urol, 31, 1497-503.
  19. Kundu JK, Surh YJ (2008). Inflammation: gearing the journey to cancer. Mutat Res, 659, 15-30.
  20. Leitzmann MF, Rohrmann S (2012). Risk factors for the onset of prostatic cancer: age, location, and behavioral correlates. Clin Epidemiol, 4, 1-11.
  21. Lippi G, Targher G, Montagnana M, et al (2009). Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Laboratory Med, 133, 628-32.
  22. Maruyama S, Hirayama C, Yamamoto S, et al (2001). Red blood cell status in alcoholic and non-alcoholic liver disease. J Laboratory Clin Med, 138, 332-7.
  23. Nelson JE, Harris RE (2000). Inverse association of prostate cancer and non-steroidal anti-inflammatory drugs (NSAIDs):Results of a case-control study. Oncology Reports, 7, 169-70.
  24. McArdle PA, Qayyum T, McMillan DC (2010). Systemic inflammatory response and survival in patients with localised prostate cancer: 10-year follow-up. Urol Int, 84, 430-5.
  25. Mengus C, Le Magnen C, Trella E, et al (2011). Elevated levels of circulating IL-7 and IL-15 in patients with early stage prostate cancer. J Transl Med, 9, 162.
  26. Mitchell RMS, Robinson TJ (2002). Monitoring dietary compliance in coeliac disease using red cell distribution width. Int J Clin Practice, 56, 249-50.
  27. Nonomura N, Takayama H, Kawashima A, et al (2010). Decreased infiltration of macrophage scavenger receptorpositive cells in initial negative biopsy specimens is correlated with positive repeat biopsies of the prostate. Cancer Sci, 101, 1570-3.
  28. Odom BD, Mir M, Hughes S, et al (2013). Active surveillance for low-risk prostate cancer in African American men: A multi-institutional experience. Urology, 83, 364-8.
  29. Ozkalemkas F, Ali R, Ozkocaman V, et al (2005). The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: A clinical study of 19 cases. Bmc Cancer, 5, 144.
  30. Patel KV, Ferrucci L, Ershler WB, et al (2009). Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med, 169, 515-23.
  31. Patel KV, Semba RD, Ferrucci L, et al (2010). Red cell distribution width and mortality in older adults: a metaanalysis. J Gerontol A Biol Sci Med Sci, 65, 258-65.
  32. Sooriakumaran P, Srivastava A, Christos P, et al (2012). Predictive models for worsening prognosis in potential candidates for active surveillance of presumed low-risk prostate cancer. Int Urol Nephrol, 44, 459-70.
  33. Perlstein TS, Weuve J, Pfeffer MA, et al (2009). Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med, 169, 588-94.
  34. Sfanos KS, De Marzo AM (2012). Prostate cancer and inflammation: the evidence. Histopathol, 60, 199-215.
  35. Shah R, Mucci NR, Amin A, et al (2001). Postatrophic hyperplasia of the prostate gland: neoplastic precursor or innocent bystander? Am J Pathol, 158, 1767-73.
  36. Siegel R, DeSantis C, Virgo K, et al (2012). Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin, 62, 220-41.
  37. Spell DW, Jones DV, Harper WF, et al (2004). The value of a complete blood count in predicting cancer of the colon. Cancer Detection Prev, 28, 37-42.
  38. Walsh SR, Cook EJ, Goulder F, et al (2005). Neutrophillymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol, 91, 181-4.
  39. Wang J, Yang J, Zou Y, et al (2013). Orphan nuclear receptor nurr1 as a potential novel marker for progression in human prostate cancer. Asian Pac J Cancer Prev, 14, 2023-8.

Cited by

  1. Is Early Detection of Colon Cancer Possible with Red Blood Cell Distribution Width? vol.16, pp.2, 2015,
  2. Assessment of the relationship between red blood cell distribution width and preganecy hypertension disease vol.42, pp.10, 2016,
  3. The red distribution width and the platelet distribution width as prognostic predictors in gastric cancer vol.17, pp.1, 2017,
  4. Mean Platelet Volume, Red Cell Distribution Width, and Neutrophil-to-Lymphocyte Ratio Before and After Surgery in Patients With Carotid Body Tumors vol.28, pp.7, 2017,
  5. Clinical implications of pretreatment inflammatory biomarkers as independent prognostic indicators in prostate cancer pp.08878013, 2017,
  6. Association Between Hemogram Parameters and Survival of Critically Ill Patients pp.1525-1489, 2017,
  7. Utility of Red Cell Distribution Width as a Prognostic Factor in Young Breast Cancer Patients vol.95, pp.17, 2016,
  8. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer vol.7, pp.1, 2017,
  9. Evaluation of complete blood count parameters to predict endometrial cancer vol.32, pp.6, 2018,
  10. Prognostic impact of the red cell distribution width in esophageal cancer patients: A systematic review and meta-analysis vol.24, pp.19, 2018,
  11. Prognostic role of RDW in hematological malignancies: a systematic review and meta-analysis vol.18, pp.1, 2018,
  12. Evaluation of the clinical value of hematological parameters in patients with urothelial carcinoma of the bladder vol.97, pp.14, 2018,
  13. A prognostic parameter in advanced non-small cell lung cancer: the ratio of hemoglobin-to-red cell distribution width pp.1437-7772, 2019,