title: Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Orlando, FL 34747, USA. Vipul.Patel.MD@flhosp.org
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
authors.forename: Ananthakrishnan
authors.initials: A
authors.lastname: Sivaraman
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Palmer
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Orvieto
authors.forename: Ignacio
authors.initials: I
authors.lastname: Camacho
authors.forename: Geoff
authors.initials: G
authors.lastname: Coughlin
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
mesh_terms: D000367:Age Factors; D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000209:etiology; D005431:Florida; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen