'Trifecta' after radical prostatectomy: is there a standard definition?

Area of Science:

• Urology
• Oncology
• Surgical Outcomes Research

Background:

• The 'trifecta' outcome after radical prostatectomy (RP) is crucial for assessing treatment success.
• Existing literature shows significant variability in defining the trifecta's components: undetectable prostate-specific antigen (PSA), urinary continence, and potency.

Purpose of the Study:

• To systematically review and quantify the variability in trifecta definitions in published RP literature.
• To establish a consensus definition for the trifecta to standardize reporting and facilitate comparative studies.

Main Methods:

• A systematic review of PubMed-indexed articles from January 2003 to March 2012 was conducted.
• Search terms included 'radical prostatectomy,' 'prostatectomy outcome,' and 'trifecta'.
• Analysis focused on identifying and categorizing different definitions for PSA, continence, and potency.

Main Results:

• Out of 86 identified publications, 14 met the inclusion criteria.
• Significant heterogeneity was observed in definitions: 8 for biochemical recurrence (PSA ≥0.2 ng/mL most common), 10 for potency, and 9 for continence (wearing no pads most common).
• Only 6 of the 14 studies utilized validated questionnaires for outcome assessment.

Conclusions:

• The definitions of the trifecta following radical prostatectomy are highly inconsistent across the literature.
• A proposed consensus definition includes: PSA >0.2 ng/mL with confirmation, erections sufficient for intercourse (with or without medication), and zero pad usage.
• Adoption of this consensus definition is recommended for future study design and outcome reporting in radical prostatectomy.