Longitudinal analysis of trifecta outcome in Japanese patients with prostate cancer following robot-assisted laparoscopi
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ORIGINAL ARTICLE
Longitudinal analysis of trifecta outcome in Japanese patients with prostate cancer following robot‑assisted laparoscopic radical prostatectomy Shogo Inoue1 · Keisuke Hieda1 · Testutaro Hayashi1 · Jun Teishima1 · Akio Matsubara1 Received: 16 July 2020 / Accepted: 27 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To analyze the trifecta outcome (continence, potency, and cancer control) longitudinally using robot-assisted laparoscopic radical prostatectomy (RARP). Method We prospectively obtained 1-year longitudinal Expanded Prostate Cancer Index Composite (EPIC) data (preoperative and at 3, 6, 9, and 12 months after RARP) from 291 patients who underwent RARP by a single surgeon. 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. Continence and potency were subjectively determined from patient-reported outcomes (EPIC question nos. 5 and 18). The biochemical recurrence (BCR) rate was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. Outcomes of the pentafecta were complications and positive surgical margins combined with the trifecta outcomes. Results Trifecta was achieved in 4.6, 5.6, 8.1, and 9.6% of all patients at 3, 6, 9, and 12 months, respectively. Pentafecta rates were 2.3, 3.0, 5.1, and 6.1%, respectively. Trifecta rates in the nerve-sparing (NS) group were 12.5, 12.7, 18.9, and 23.6%, respectively. The BCR-free rates maintained a high level and were 94.4, 93.9, 93.9, and 90.9%, respectively. Continence rates were improved to 55.2, 75.5, 81.6, and 85.0%, while the potency rate was extremely low at 7.5, 7.8, 9.8, and 10.9%. Even in the NS group, potency rates remained low at 18.1, 18.6, 21.9, and 26.1%, respectively. Conclusion This longitudinal analysis of trifecta outcomes may be beneficial and should be used when counseling patients with clinically localized PCa. Keywords Robot-assisted laparoscopic radical prostatectomy · Sexual function · Quality of life · Trifecta · Longitudinal evaluation
Introduction With the widespread use of the prostate-specific antigen (PSA) test, patients are now frequently diagnosed with low grade and low-stage prostate cancer (PCa) [1, 2]. Radical prostatectomy (RP) is recognized as an effective treatment for clinically localized PCa. As a result, disease-free survival (DFS) rates approach 90% at 5 years after RP [3]. Other approaches, such as radiation therapy offer a similar DFS. * Shogo Inoue inosyogo@hiroshima‑u.ac.jp 1
Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima 734–8551, Japan
Treatments with comparable DFS rates should be evaluated in terms of quality of life (QOL), including continence and potency [4]. The implementation of the robotic surgical system in the field of urology has brought with it the advantages of three-dimensional binocular magnification, motion scali
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