Following surgery, there are three main objectives that must be discussed and followed during your recovery. These are coined the term "trifecta" and include:
1) Oncological cure
2) Return of urinary control (continence)
3) Recovery of sexual function (potency)
Oncologic (Cancer-Related) Cure
Prostate cancer recurrence is highly related to several pre-operative and post-surgical pathology parameters. These include:
- Pre-operative PSA level
- Pathology final: Gleason score
- Pathologic stage (capsular involvement and seminal vesicle involvement)
- Margin status
A thorough discussion of these details will take place on your initial post-operative visit for catheter removal.
After complete removal of the prostate and accessory organs, the PSA level should decrease to an undetectable (<0.01 ng/mL) level within four to six weeks of surgery. If the prostate cancer has been completely eradicated, the PSA should remain zero for the rest of your life. If there were to be a recurrence of disease, the PSA would become detectable on the blood test. As such, following radical prostatectomy, you will be evaluated in the urology clinic every three months for the upcoming year and every six months the second year after surgery. If the PSA remains zero to that point and there are no high risk pathological features (such as extracapsular extension of the tumor, invasion of cancer into the seminal vesicles or lymph nodes, or positive surgical margins), a yearly PSA would be recommended. In the event of high risk pathologic features, your case will likely be presented at the weekly inter-disciplinary uro-oncology rounds to discuss the need for additional therapy.
Urinary Function Recovery
University of Chicago Continence Rehabilitation Protocol
Sexual Function Recovery
University of Chicago Continence Rehabilitation Protocol
A recent review of our 1,600 patient database for trifecta outcome include:
| Table. Recurrence -free, Potency, Continence and Trifecta rates. | ||||
| Subjective1 | Objective2 | P value | 95% CI3 | |
|---|---|---|---|---|
| NED % (N/total) | ||||
| 3 moths | - | 99% (351/356) | - | - |
| 6 months | - | 97% (326/336) | - | - |
| 12 months | - | 96% (285/298) | - | - |
| 24 months | - | 91% (111/122) | - | - |
| Continence % (N/total) | ||||
| 3 months | 57% (163/288) | 33% (77/235) | <0.0001 | 16-32% |
| 6 months | 80% (230/287) | 60% (151/252) | <0.0001 | 12-28% |
| 12 months | 92% (269/291) | 73% (177/240) | <0.0001 | 13-26% |
| 24 months | 98% (159/163) | 80% (74/92) | <0.0001 | 10-27% |
| Potency % (N/total) | ||||
| 3 months | 57% (171/302) | 44% (114/258) | 0.003 | 5-21% |
| 6 months | 63% (166/263) | 50% (124/250) | 0.004 | 4-21% |
| 12 months | 82% (226/277) | 62% (145/235) | <0.0001 | 12-28% |
| 24 months | 93% (155/167) | 69% (62/90) | <0.0001 | 14-35% |
| Trifecta % (N/total) | ||||
| 3 months | 34% (98/288) | 16% (42/262) | <0.0001 | 11-25% |
| 6 months | 52% (136/262) | 31% (76/249) | <0.0001 | 13-29% |
| 12 months | 71% (185/261) | 44% (106/240) | <0.0001 | 18-35% |
| 24 months | 76% (78/102) | 44% (39/88) | <0.0001 | 18-44% |
Key: NED= no evidence of disease; CI=confidence interval;
- Based on the patient-physician encounter (continent=pad free or security pad; potent=able to achieve intercourse).
- Based on UCLA-PCI questionnaire (continent=pad free-question 14; potent= erection sufficient for intercourse- question 23)
- CI calculated for the difference between the two proportions.
