'Trifecta' after radical prostatectomy: is there a standard definition?. (11th June 2013)

• Record Type: Journal Article
• Authors: Borregales, Leonardo D.; Berg, William T.; Tal, Oded; Wambi, Chris; Kaufman, Sarah; Gaya, Jose M.; Urzúa, Cristian; Badani, Ketan K.
• Is Part Of: BJU international. Volume 112:Number 1(2013:Jul.)
• Page Start: 60
• Page End: 67
• Publication Date: 2013-06-11
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12002
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12002-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12002-list-0001" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting.</p> </list-item> </list> </p> </sec> <sec id="bju12002-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p> <list id="bju12002-list-0002" list-type="bullet"> <list-item> <p>A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed.</p> </list-item> <list-item> <p>The search queries included the keywords 'radical prostatectomy, ' 'prostatectomy outcome, ' and 'trifecta'.</p> </list-item> </list> </p> </sec> <sec id="bju12002-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12002-list-0003" list-type="bullet"> <list-item> <p>A total of 86 publications were identified of which 14 were used for analysis.</p> </list-item> <list-item> <p>Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL.</p> </list-item> <list-item> <p>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'.</p> </list-item> <list-item> <p>Nine different definitions of continence were found. The most common definition of continence was 'wearing no pads'.</p> </list-item> <list-item> <p>Only six of the 14 articles used validated questionnaires in their outcome measures.</p> </list-item> </list> </p> </sec> <sec id="bju12002-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12002-list-0004" list-type="bullet"> <list-item> <p>The definitions of trifecta reported in the literature are highly variable.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>