title: Evaluation of combined oncologic and functional outcomes after robotic-assisted laparoscopic extraperitoneal radical prostatectomy: trifecta rate of achieving continence, potency and cancer control.
abstract: OBJECTIVE
  Outcomes of continence, erectile function, and oncologic control are well-described in isolation especially for the retropubic open approach. However, only few series have yet reported combined results after radical prostatectomy. To determine the proportion of men who are continent, potent, and cancer-free (trifecta rate) 2 years after robot-assisted laparoscopic radical prostatectomy (RALRP).
  
  
  METHODS
  We included patients who underwent a RALRP at our department and who were followed during at least 2 years. Men who were impotent or incontinent before the surgery were excluded from the analysis. Overall, 500 men were included. All patients prospectively completed validated questionnaires (IIEF-5, ICS) before the medical visit and concerning their voiding and sexual disorders, preoperatively, 3, 6, 12, 18, and 24 months after RALRP. Biochemical recurrence was defined as any detectable serum PSA (≥ 0.2 ng/ml). The study end point was the trifecta rate (cancer control, continence, and potency) at 2 years of the surgery. Predictive factors of the trifecta outcome were assessed in univariate and multivariate analyses.
  
  
  RESULTS
  Median age and PSA level were 62.2 years and 9.7 ng/mL. A trifecta outcome was achieved in 44% and 53% of men at 12 and 24 months, respectively. The 2-year trifecta rate reached 62% in men undergoing bilateral nerve-sparing surgery and 71% in men < 60 years. Age < 60 years, PSA level < 10 ng/ml, organ-confined disease, and bilateral nerve-sparing procedure were significantly associated with the 2-year trifecta outcome.
  
  
  CONCLUSIONS
  Two years after RALRP, the trifecta outcome is achieved in 53% of preoperatively potent and continent men.
authors: Departments of Urology and Pathology APHP, CHU Henri Mondor, Créteil, France. evanguelosxylinas@hotmail.com
authors: Evanguelos
authors: E
authors: Xylinas
authors: Xavier
authors: X
authors: Durand
authors: Guillaume
authors: G
authors: Ploussard
authors: Alexandre
authors: A
authors: Campeggi
authors: Yves
authors: Y
authors: Allory
authors: Dimitri
authors: D
authors: Vordos
authors: Andras
authors: A
authors: Hoznek
authors: Claude Clément
authors: CC
authors: Abbou
authors: Alexandre
authors: A
authors: de la Taille
authors: Laurent
authors: L
authors: Salomon
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012371:Robotics; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000209:etiology