Trifecta outcomes after robot-assisted laparoscopic radical prostatectomy

What's known on the subject? and What does the study add? The ideal outcome following radical prostatectomy includes presence of undetectable PSA, and full recovery of urinary continence and erectile function (the so called trifecta outcome). Very few studies are indeed available on the trifecta outcome following retropubic radical prostatectomy and a single one reported trifecta outcome following robot-assisted radical prostatectomy. We found that 1-year after surgery 89% of the patients were continent, 60% were potent and 95.5% were with undetectable PSA and without adjuvant therapies. On the whole, trifecta outcome was achieved by 57% of the patients. On multivariable analysis, patients age at surgery and preoperative erectile function were independent predictors of trifecta. OBJECTIVE To evaluate the trifecta outcome and its preoperative predictors in a series of consecutive patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS We collected prospectively the clinical data of 242 consecutive patients with a minimum 12-month follow-up undergoing RALP for clinically localized prostate cancer. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the International Index of Erectile Function (IIEF)-6 were used to evaluate the functional outcomes. Patients receiving adjuvant therapies or with a PSA at follow-up > 0.2 ng/mL were censored for the biochemical recurrence-free analysis. Logistic regression was used to perform univariable and multivariable analyses. RESULTS Twelve months after surgery, 216 patients (89%) were continent and 145 (60%) were potent. At a median follow-up of 14 mo, 11 patients (4.5%) had either adjuvant radiation therapies within 3 months of surgery, when PSA was still undetectable (n = 6, 2.5%), or salvage radiation or hormone plus radiation therapy for PSA relapse (n = 5, 2%). A trifecta outcome was achieved by 137 patients (57%). On univariable regression analysis, patients' age at surgery (P < 0.001), body-mass index (P = 0.028), preoperative IIEF-6 score (P < 0.001) and prostate volume (P = 0.036) were significantly associated with trifecta rates. On multivariable analysis, only patients' age at surgery (odds ratio 1.095; P = 0.005) and preoperative IIEF-6 score (odds ratio 0.803; P < 0.001) were independent predictors of trifecta rates. CONCLUSION Using validated questionnaires to assess functional outcomes, we found that 57% of our patients undergoing nerve-sparing RALP achieved the trifecta outcome 12 months after surgery. Patient age at surgery and preoperative erectile function were the only independent predictors of trifecta rates.