A Randomized Study of the Efficacy of Low Venous Pressure General Anesthesia Versus Combined Spinal-Epidural Anesthesia in Decreasing Blood Loss During Prostate Surgery

Inclusion Criteria:

* They are scheduled for RRP by Drs. Scardino or Eastham.
* They speak English in order to cooperate during CSE if randomized to such arm.
* They have clinically localized disease, clinical stage \< cT3NxM0 (1997 TNM), any Gleason grade
* Must be willing to receive blood products or blood if deemed clinically necessary
* Must be willing to receive epidural or general anesthesia
* All subjects must be age 18 or older
* Patient or the patient's legally acceptable representative must sign and date informed consent PRIOR to any study related procedures being performed.
* Patient must have an MRI of the prostate done at MSKCC prior to RRP.

Exclusion Criteria:

* Prior history of significant cardiac disease (defined as unstable angina, coronary artery stent placement within 8 weeks of surgery, MI within 6 months of surgery, known history of cardiomyopathy, congestive heart failure or significant valvular heart disease), insulin dependent diabetes mellitus, or clinically significant carotid artery disease.
* Presence of renal insufficiency (define by creatinine level \> 1.6 mg/dl).
* Prior radiation therapy to the pelvis or prostate
* History of bleeding tendencies, hemorrhagic diathesis, or known primary or secondary hematological disease such as chronic renal failure, Von Willebrand disease, and thrombocytopenia among others.
* History of lumbar spine disease or peripheral neurological conditions that may contraindicate use of CSE anesthesia.
* Prior transurethral resection of the prostate or a suprapubic prostatectomy
* Prior history of an abdominal perineal resection or local excision of a colorectal cancer
* Patients requiring anticoagulation due to a pre-existing medical illness or increased risk for thromboembolic events such as prior history of pulmonary embolus, morbid obesity, atrial fibrillation, mechanical heart valve, etc.
* History of morphine allergy
* History of fentanyl allergy
* History of allergy to local anesthetics