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...