Public Domain

Public Domain

Most of us have heard of the word, trifecta, especially as used in the horse racing world, but it can also mean “winning” three things in a row – a triple win if you will. Well urologists also use the term for men who undergo a radical prostatectomy or complete removal of the prostate.

What exactly is the trifecta or triple win after prostate surgery? It’s a very ambitious undertaking to accomplish three goals for you, the patient.

Trifecta Goal #1 Control and/or eliminate the prostate cancer in your body.

This of course has to be the most important goal of any treatment for prostate cancer – take care of the number one problem – eliminate the disease from your body.

Trifecta Goal #2 Urinary Continence

This is huge also. You’ve got to get your urinary control back after prostate surgery. If you don’t, your quality of life will be affected on a daily basis.

Trifecta Goal # 3 Potency

A few short years ago, before Dr. Patrick C. Walsh did his research on the nerve sparing technique in radical prostate surgery, men had almost no chance of regaining their erectile function. Urologists today have benefited from Dr Walsh’s research and make every attempt to spare the nerves that facilitate erections wherever and whenever possible. However, every case of prostate cancer is different.

Research Study

A team of researchers from Columbia University (Borregales L.D., Berg W.T., et al) conducted an interesting study in which they examined 86 publications of scientific studies that dealt with the trifecta after radical prostatectomy. What they found was that the definition of the three goals was “highly variable,” that is, not standardized.

What does continence mean exactly? How do you define potency? Is the cancer controlled? They proposed the following definitions to standardize the research definitions.

For cancer control, the goal is to achieve a PSA reading of <.02ng/mL on both an initial blood test and a second-confirmatory blood test. Continence means no need for any pads or “zero pads.” Potency means ESI (Erection Sufficient for Intercourse) with or without the use of an oral drug like Viagra, Levitra, or Cialis.

I was a prostate surgery patient, and I say why stop at the trifecta? I added several more goals to make this a decafacta or ten goal affair. You can read about my urological decafecta here.



Borregales L.D, Berg W.T., Tal O., Wambi C., Kaufman S., Gaya J.M., Urzúa C., Badani K.K., (2013) ‘Trifecta’ after radical prostatectomy: is there a standard definition?

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