Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

Eastham, James A.; Scardino, Peter T.; Kattan, Michael W.

doi:10.1016/j.juro.2008.01.106

Cited by 179 publications

(142 citation statements)

References 8 publications

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“…Postoperative urinary continence outcomes for RARP, LRP, and RRP are tabulated in Table 7, 16,17,[23][24][25]27,[32][33][34][35][59][60][61] Table 9. 35,48,50,51,53,58,63,64 Direct comparisons for urinary continence rates between different prostatectomy series are difficult because of variations in definitions, data collection methods, and length of follow-up.…”

Section: Urinary Continence Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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Section: Urinary Continence Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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“…Several trials have indicated that the best postoperative potency rates are obtained in the younger patient population. [11][12][13][14] Younger patients are more likely to have better preoperative erectile function and to be more interested in sexual recovery after surgery. [11][12][13][14] Patients between ages 40 years and 49 years reported rates of erectile function recovery as high as 92%.…”

Section: Patient and Partner Agementioning

confidence: 99%

“…Several studies have demonstrated that the surgical approach is key for maintaining erectile function after RP. [11][12][13][14] Indeed, the volume of neural tissue preserved is associated linearly with the quality of erection after surgery. Patients with both NVBs preserved are more likely to recover erectile function after surgery (Table 1).…”

Section: Cormorbidity Profilementioning

confidence: 99%

“…Patients with both NVBs preserved are more likely to recover erectile function after surgery (Table 1). [11][12][13][14]16 In 2000, Rabbani and colleagues, using a rigorous statistical method, demonstrated for the first time that the volume of neural tissue preserved is crucial for postoperative potency. 11 Several other studies have confirmed those results.…”

Section: Cormorbidity Profilementioning

confidence: 99%

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Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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“…Of note, individually,P SA free survival, continence and potency rates were 85%, 66% and 33%, respectively.Bianco et al reported aT rifecta rate of 60% at 2y ears after RRP (45). Morer ecently, Eastham et al described their Trifecta rate at 62% at 2 years (46). Only one report of outcomes in RARP patients is available.…”

Section: Trifectaoutcomesmentioning

confidence: 99%

Evolution of Robot-Assisted Radical Prostatectomy

Orvieto

Patel

2009

Scand J Surg

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Introduction and Objective: Open radical prostatectomy (RRP) is the gold standard and most widespread treatment for clinically localized prostate cancer.H owever,i nr ecent years robot-assisted laparoscopic prostatectomy (RARP) is rapidly gaining acceptance among urologists worldwide. We sought to outline our surgical technique of robotic radical prostatectomy and provide practical recommendations based on available reports and personal experience. We also critically review the current experience on RARP worldwide and compare the available data with the gold standard open RRP series.Material and Methods: As ystematic review of the literature was performed for all published manuscripts between 1997 and 2008 using the keywords -' robotic radical prostatectomy, 'robot-assisted radical prostatectomy', 'laparoscopic radical prostatectomy' and 'robotic' using the Medline database.Results: At otal of 226 original manuscripts on RARP were identified. Manuscripts were selected according to their relevance to the current topic (i.e. original articles, number of patients in the series, prospective data collection) and incorporated into this review.Conclusions: Eight years after the first RARP,m ultiple series are mature enough to demonstrate safety,efficiency and reproducibility of the procedure, as well as oncologic and functional outcomes comparable to its open counterpart. Further prospective, randomized studies comparing both surgical techniques are necessary in order to draw more definitive conclusions.

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Predicting an Optimal Outcome After Radical Prostatectomy: The Trifecta Nomogram

Cited by 179 publications

References 8 publications

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Prediction of sexual function after radical prostatectomy

Evolution of Robot-Assisted Radical Prostatectomy

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