‘Trifecta’ after radical prostatectomy: is there a standard definition?

Abstract

Objectives To determine the extent of variability in the definitions of the ‘trifecta’ after radical prostatectomy (undetectable PSA, urinary continence and potency) to be found in the literature. To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting. Materials and Methods A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed. The search queries included the keywords ‘radical prostatectomy,’ ‘prostatectomy outcome,’ and ‘trifecta’. Results A total of 86 publications were identified of which 14 were used for analysis. Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL. The definition of potency was the most variable. Ten different definitions of potency were found, with the most common being ‘having erections sufficient for intercourse with or without a phosphodiesterase‐5 inhibitor’. Nine different definitions of continence were found. The most common definition of continence was ‘wearing no pads’. Only six of the 14 articles used validated questionnaires in their outcome measures. Conclusions The definitions of trifecta reported in the literature are highly variable. We propose the following consensus definition based on our analysis: (1) PSA >0.2 ng/mL with confirmatory value; (2) attainment of erections sufficient for intercourse with or without oral pharmacological agents; (3) wearing zero pads. This consensus definition should be considered when designing studies and reporting outcomes of radical prostatectomy.

Does Surgeon Subjective Nerve Sparing Score Predict Recovery Time of Erectile Function Following Robot-Assisted Radical Prostatectomy?

“…Lewis et al recommended the use of validated questionnaires such as the International Index of Erectile Function (IIEF) to examine the EF [21]. Borregales et al also recommended the adoption of SHIM (a simpler version of IIEF) as the reliable method to determine the EF after prostatectomy [22]. Although the most commonly cited definition of potency was "the achievement of erection sufficient for intercourse with or without a PDE5 inhibitor," this definition does not evaluate quantitative changes in erectile frequency or quality and needs to be modified in future studies.…”

Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

“…We also evaluated the “trifecta” (undetectable PSA, continence and potency) and “pentafecta” (trifecta plus no postoperative complications and negative surgical margins) rates in the two groups ( 17 , 18 ).…”

Comparison of various continence definitions in a large group of patients undergoing radical prostatectomy: a multicentre, prospective study

“…This inconsistency in defining continence, exacerbated by the heterogeneity of used study designs and samples, data collection methods, measuring instruments, and lengths of follow-up, makes it extremely difficult to compare published results. This has been widely recognized among contemporary research literature (e.g., [16–18]). This paper’s main objective is then to identify the best possible definition of continence and thus help prevent the distortion of reported outcomes.…”