Dear Editor,

The response by Prof Francesco Montorsi to the rapid response of Prof Neal is interesting and needs evaluation. In the current era, a blood transfusion rate of 55% in the UK will definitely bring the centre under scrutiny for its surgical techniques. Indeed, situations such as these and indeed oncological outcomes has led to centralisation of cancer services within the NHS in the UK.

I strongly disagree to the last sentence of Prof Montorsi in his reply. To quote "In conclusion, we feel that the message of our study is very strong and that tranexanic acid should be considered by surgeons performing open radical prostatectomy with the attempt to achieve excellent cancer control and postoperative functional outcomes."

I have to high-light to the readers that cancer control and post-operative functional outcomes has not been either the primary or the secondary outcomes of this RCT study. This has not been demonstrated and should not be quoted unless the data is made available for peer-review and scrutiny.

Competing interests: The Author is a Convert from Open Surgery to Robotic Surgery