Oncological and functional outcomes following open radical prostatectomy: how patients may achieve the "trifecta"?

Abstract

Purpose:The desirable outcomes after open radical prostatectomy (RP) for localized prostate cancer (PC) are to: a) achieve disease recurrence free, b) urinary continence (UC), and c) maintain sexual potency (SP). These 3 combined desirable outcomes we called it the "Trifecta". Our aim is to assess the likelihood of achieving the Trifecta, and to analyze the influencing the Trifecta . Materials and Methods: A total of 1738 men with localized PC underwent RP from 1992-2007 by a single surgeon. The exclusion criteria for this analysis were: preoperative hormonal or radiation therapy, preoperative urinary incontinence or erectile dysfunction, follow-up less than 24 months or insufficient data. Post-operative Trifecta factors were analyzed, including biochemical recurrence (BR).. We defined: BR as PSA ≥ 0.2 ng/mL, urinary continence as wearing no pads, and sexual potency as having erections sufficient for intercourse with or without a phosphodiesterase-5 inhibitor.Results: A total of 831 patients met the inclusion criteria. The mean age of the entire cohort was 59 years old. The median follow-up was 52 months (mean 60, range . The BR, UC and SP rates were 18.7%, 94.5%, and 71% respectively. Trifecta was achieved in 64% at 2 year follow-up, and 61% at 5 year follow-up. Multivariate analysis revealed age at time of surgery, pathologic Gleason score (PGS), pathologic stage, specimen weight, and nerve sparing (NS) were independent factors. Conclusions: Age at time of surgery, pathologic GS, pathologic stage, specimen weight and NS were independent predictors to achieve the Trifecta following radical prostatectomy. This information may help patients counseling undergoing radical prostatectomy for localized prostate cancer.Key words: Radical Prostatectomy; treatment outcome; prostate cancer; recurrence Int Braz J Urol. 2011; 37: 320-327 INTRODUCTIONOpen Radical prostatectomy (RP) is an effective treatment for clinically localized prostate cancer. In the era of PSA screening, patients are often diagnosed with low grade, low stage prostate cancer. Consequently, disease free survival (DFS) rates approach 90% at 5 years post TP. (1). Other approaches, like radiation therapy, provide similar DFS. Treatments with comparable DFS rates should be evaluated in terms of quality of life (QoL) including continence and erectile function, as well as cancer control.Better knowledge of pelvic anatomy, improvements in surgical technique (2), and early detection (PSA), have led to improved oncological results and reduced adverse functional outcomes (3). Full continence, erectile function, and absence of biochemical recurrence (BR) represent the Trifecta, the most desired outcomes following TP (4). BR is assessed with serial serum PSA measurements. However, QoL outcomes being subjective in nature are tabulated as an objective endpoint. Although the methodology of assessing the outcome is critical, there are no universally accepted guidelines for Several endpoints have been used to evaluate postoperative UC. The rates following RP var...

The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D'Amico risk criteria

“…20 Antebi et al also found that both the continence and potency rates 54 months after a RRP were not significant difference in the low-, intermediate-, and high-risk groups. 21 Thus, we agree with the conclusion of Schmitges et al that the perception of higher rates of urinary incontinence, erectile dysfunction, and perioperative complications after a RP in high-risk patients is not supported by the current literature. 28 Neurovascular bundle-sparing during roboticassisted laparoscopic radical prostatectomy In our study 94 of 300 patients underwent a bilateral NVB-sparing procedure with RARP.…”

“…28 On the contrary, Antebi et al reported that the BCR-free and trifecta rates significantly decreased from low-, then intermediate-, and lastly, to high-risk patients 54 months after a RRP. 21 Pierorazio et al reported that the BCR-free rate was 96.4, 90.3, and 78.7% in the low-, intermediate-, and high-risk groups, respectively, at a median follow-up period of 4.4, 4.8, and 7.1 years after RRP, respectively (P < 0.001). 20 Pierorazio et al also reported that the trifecta rate significantly decreased from low-(72.6%), to intermediate-(58.1%), and to high-risk (40%) cases.…”

“…20 However, a bilateral NVB was performed in 83 and 63.5% of cases in Pierorazio et al and Antebi et al studies, respectively. 20,21 Furthermore, in Pierorazio et al, the high-risk population had a significantly longer follow-up period than the low-and intermediately-risk patients, which may potentially introduce bias into the analyses. 20 …”

Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis

“…Antebi et al reported trifecta following open radical prostatectomy. Trifecta at 2 and 5 years was achieved in 64% and 61% of patients respectively ( 29 ). Bianco et al reported a trifecta rate of 60% at 2 years in 758 men after RRP ( 30 ).…”

Analysis of the use of integral combinations of efficacy radical prostatectomy and the evaluation of a new method for the formation of vesico-urethral anastomosis in endoscopic radical prostatectomy in patients with clinically localized prostate cancer

“…У групі низького ризику (52% хворих) БхР діагностовано у 12,7%, відновлення ЕФ -у 73,5%, УС -у 93,7%, трифекти через 54 міс досягнуто у 62,4% хворих, у групі проміжного ризику (35% хворих) відповідно: БхР -у 22,4%, відновлення ЕФ -у 69,5%, УС -у 94,2%, три фекти досягнуто у 52,4%. У групі високого ризику (13% хво рих) за D'Amico БхР діагностовано у 40,8% хворих, ЕФ збе режена у 67,0%, УС відновлено у 93,1% хворих, а трифекта констатована у 43,0% хворих.У ході дослідження виявлено міжгрупове статистично значуще збільшення частоти виявлення із БхР та зменшення кількості хворих, які досягли трифекти у групах хворих від низького до високого ризику за D'Amico (p<0,001)[26]. Окрім того, хірургами виконувалось збереження ший ки сечового міхура та пубоуретральної частини пубоуретраль них зв'язок.…”