Introduction: Our objective was to analyze the trifecta outcome (continence, potency, and cancer control) longitudinally in robot-assisted laparoscopic radical prostatectomy (RARP).
Methods: We prospectively obtained one-year longitudinal Expanded Prostate Cancer Index Composite (EPIC) data (preoperative and at 3, 6, 9, and 12 months after RARP) from 458 patients who underwent RARP performed by a single surgeon. Of these, we excluded 167 patients with incontinence or erectile dysfunction patients at preoperative. Continence was defined as the use of ‘zero or one pads’. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual activity or sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP.
Results: Patient characteristics are listed in Table 1. Trifecta was achieved in 4.6, 5.6, 8.1, and 9.6% of patients at 3, 6, 9, and 12 months, respectively. Trifecta rates in the nerve-sparing group were 12.9, 12.7, 18.9, and 22.5%, respectively (Fig. 1). Cancer control rates maintained a high level longitudinally and these rates were 94.4, 93.9, 93.9, and 90.0%, respectively. Continence rate was improved to be 55.2, 75.5, 81.6, and 85.0%. On the other hand, the potency rate was extremely low, at 7.5, 7.8, 9.8, and 10.9%(Fig. 2). Even in nerve-sparing group, the cancer control rate was very high and continence was recovered, which suggests similar tendencies among cancer control and continence. Potency rate remained low at 19.4, 18.6, 21.9, and 25.0%, respectively.
Conclusions: Trifecta outcomes more accurately reflect patient expectations following RARP. In our longitudinal analysis, potency rate was found to be associated with the achievement of trifecta. Source of
