Pentafecta: A new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy

Patel, Vipul R., Sivaraman, Ananthakrishnan, Coelho, Rafael F., Chauhan, Sanket, Palmer, Kenneth J., Orvieto, Marcelo A., Camacho, Ignacio, Coughlin, Geoff and Rocco, Bernardo (2011) Pentafecta: A new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. European Urology, 59 5: 702-707. doi:10.1016/j.eururo.2011.01.032

Author Patel, Vipul R.
Sivaraman, Ananthakrishnan
Coelho, Rafael F.
Chauhan, Sanket
Palmer, Kenneth J.
Orvieto, Marcelo A.
Camacho, Ignacio
Coughlin, Geoff
Rocco, Bernardo
Title Pentafecta: A new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy
Journal name European Urology   Check publisher's open access policy
ISSN 0302-2838
Publication date 2011-05-01
Sub-type Article (original research)
DOI 10.1016/j.eururo.2011.01.032
Open Access Status DOI
Volume 59
Issue 5
Start page 702
End page 707
Total pages 6
Place of publication Amsterdam, AE, Netherlands
Publisher Elsevier
Language eng
Formatted abstract

Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures.


A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed.

Design, setting, and participants

From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group.


In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta.
Results and limitations

Continence, potency, biochemical recurrence–free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta.


A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients’ expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
Keyword Minimally invasisve
Robot assisted
Radical prostatectomy
Counseling tool
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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Created: Sat, 10 Dec 2011, 00:23:01 EST by Matthew Lamb on behalf of School of Medicine