Trifecta outcomes after robot-assisted laparoscopic radical prostatectomy.
OBJECTIVE
To evaluate the trifecta outcome and its preoperative predictors in a series of consecutive patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP).


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.


CONCLUSIONS
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.
Novara
Giacomo
G
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
Ficarra
Vincenzo
V
D'Elia
Carolina
C
Secco
Silvia
S
Cavalleri
Stefano
S
Artibani
Walter
W
D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D018783:Impotence, Vasculogenic / Q000209:etiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology*