Survival, Continence and Potency (SCP) recovery after radical retropubic prostatectomy: A long-term combined evaluation of surgical outcomes
Introduction
Prostate cancer (PCa) is the most frequently diagnosed malignant neoplasm in the Western world.1 A large amount of the new cases are being detected in younger and healthier patients, often in clinically localized stage.2 Radical prostatectomy (RP), performed either by open, laparoscopic or robotic approach, is a common treatment option for such patients.3 The first objective of surgery is cancer control. However, especially in younger patients in whom the presence of urinary incontinence and erectile dysfunction could negatively affect their satisfaction and quality of life, a fast and complete functional recovery should be attained. Despite the need for an appropriate classification, most of RP outcomes are generally reported separately, and only few studies show their results according to the trifecta concept, by which the biochemical disease-free survival (bDFS), the urinary continence and potency recovery rates of those patients undergoing radical prostatectomy with bilateral nerve-sparing are considered together.4, 5 Recently, a more comprehensive methodology for reporting outcomes after RP has been proposed, the so-called pentafecta.6 In this system, along with the three major postoperative outcomes (bDFS, continence and potency), complications and surgical margin status have been included, in order to better match the surgical quality and the patient's expectations. These classification systems, however, do not allow to offer a proper outcomes interpretation in all patients: indeed, patients failing to reach the trifecta or pentafecta state are a heterogeneous group made up of patients with oncologic success and functional failure, patients with oncologic failure and functional success, and patients with both oncologic and functional failure. Therefore, by evaluating the surgical results only in those preoperatively continent and potent patients who received bilateral nerve sparing (NS), the majority of men undergoing radical prostatectomy are excluded from the evaluation. Survival, Continence and Potency (SCP) classification7 has been recently proposed with the aim to overcome these limitations, offering not only a more realistic interpretation of the results, but also being more applicable in the real life scenario. This new system provide a much more accurate sub-group classification of the results after RP, even in those patients who do not represent the “best” group category. With the aim to offer a comprehensive account of surgical outcomes on a defined cohort, we reported the combined oncological and functional outcomes according to the SCP system after a long-term follow-up, in a group of patients treated with open radical retropubic prostatectomy (RRP) for clinically localized and locally advanced prostate cancer.
Section snippets
Material and methods
We evaluated our prospectively collected Institutional Database of patients who underwent open radical prostatectomy for prostate cancer from November 1995 to September 2008. We selected only those patients consecutively treated with RRP, with a minimum follow-up of 5 years and evaluable data for the statistical analyses. Globally, 429 patients were excluded from the analyses, because were lost to follow-up or due to incomplete records (demographic, clinico-pathological, perioperative and
Results
Clinical and pathological characteristics of the cohort of 778 patients are reported in Table 2. Oncological and functional outcomes were evaluable according to the SCP classification in all patients.
Discussion
The complete cancer extirpation, the postoperative urinary continence and potency recovery are the most important outcomes in patients who have undergone RP and need to be described in a more realistic and comprehensive fashion. The present study is the first to report the combined oncological and functional outcomes according to the SCP classification after a long-term follow-up (≥5 years) in a cohort of patients who underwent RRP for clinically localized or locally advanced prostate cancer.
Conclusions
Trifecta system does not allow to properly classify oncological and functional outcomes after radical prostatectomy in most of patients. The sub-group classification of surgical results, even in those patients who do not represent the “best” category, as offered by the comprehensive Survival, Continence and Potency (SCP) classification, allow to provide a much more accurate evaluation of outcomes after RP. In our study, roughly one third of evaluable patients reached both oncological and
Conflict of interest statement
All authors have no conflicts of interest to declare.
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These authors contributed equivalently to the manuscript preparation.