Skip to main content

Advertisement

SpringerLink
Log in

Trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing, robot-assisted radical prostatectomy: a 10-year low-intermediate volume single-center experience

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

To evaluate the trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing (NS), robot-assisted radical prostatectomy (RARP) in a single low-intermediate volume prostate cancer (PCa) center over a 10-year period.

Materials and methods

We queried a prospectively maintained database for patients who underwent NS RARP between 2009 and 2018 in a low-intermediate volume PCa center. Risk-groups were defined according to the D’Amico classification. Pentafecta outcomes referred to the postsurgical presence of potency and continence, and the absence of biochemical recurrence (BCR), positive surgical margins (PSM), and perioperative complications. The Kruskall–Wallis test, the t test and the Mann–Whitney tests were used when appropriate.

Results

603 patients underwent NS RARP and 484 patients were evaluated for Pentafecta outcomes. Median postsurgical follow-up was 28 months. Overall, 137 (22.7%), 376 (62.3%), and 90 (15%) patients were diagnosed in the low-, intermediate-, and high-risk groups, respectively. Patients undergoing NS RARP shifted from 33 to 20% in the low-risk group, from 52 to 62% in the intermediate-risk group, and from 10 to 13% in the high-risk group. Patients reaching Pentafecta increased from 38 to 44%. No postoperative potency was the main reason for non-achieving Pentafecta (71%). BCR strongly limited Pentafecta achievement in the high-risk group (61%), but not in intermediate (24%) and low-risk (30%) groups.

Conclusions

Low-intermediate volume PCa centers show similar trends to high-volume centers regarding risk group distributions over time in PCa patients undergoing NS RARP. We reported an increase in Pentafecta outcomes achievement over time even for experienced surgeons. Pentafecta outcomes achievement is risk-group dependent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

PSA:

Prostate specific antigen

PCa:

Prostate cancer

BCR:

Biochemical recurrence

NS:

Nerve sparing

RARP:

Robot-assisted radical prostatectomy

LND:

Lymph-node dissection

PSM:

Positive surgical margins

EF:

Erectile function

PDE5:

Phosphodiesterase type 5

References

  1. Galper SL, Chen M-H, Catalona WJ, Roehl KA, Richie JP, D’Amico AV (2006) Evidence to support a continued stage migration and decrease in prostate cancer specific mortality. J Urol 175(3):907–912

    Article  Google Scholar 

  2. Tosoian JJ, Carter HB, Lepor A, Loeb S (2016) Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol 13(4):205–215

    Article  Google Scholar 

  3. Moyer VA, on behalf of the U.S. Preventive Services Task Force (2012) Screening for prostate cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 157(2):120–134

    Article  Google Scholar 

  4. Butler SS, Muralidhar V, Zhao SG, Sanford NN, Franco I, Fullerton ZH (2020) Prostate cancer incidence across stage, NCCN risk groups, and age before and after USPSTF Grade D recommendations against prostate-specific antigen screening in 2012. Cancer 126(4):717–724

    Article  CAS  Google Scholar 

  5. van den Bergh R, Gandaglia G, Tilki D, Borgmann H, Ost P, Surcel C (2019) Trends in radical prostatectomy risk group distribution in a european multicenter analysis of 28,572 patients: towards tailored treatment. Eur Urol Focus. 5(2):171–178

    Article  Google Scholar 

  6. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974

    Article  Google Scholar 

  7. Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M (2016) Impact of stage migration and practice changes on high-risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades. BJU Int 117(5):740–747

    Article  CAS  Google Scholar 

  8. Salomon L, Saint F, Anastasiadis AG, Sebe P, Chopin D, Abbou C-C (2003) Combined reporting of cancer control and functional results of radical prostatectomy. Eur Urol 44(6):656–660

    Article  Google Scholar 

  9. Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59(5):702–707

    Article  Google Scholar 

  10. Jazayeri SB, Weissman B, Samadi DB (2018) Outcomes following robotic-assisted laparoscopic prostatectomy: Pentafecta and Trifecta achievements. Minerva Urol Nefrol 70(1):66–73

    PubMed  Google Scholar 

  11. Pompe RS, Tian Z, Preisser F, Tennstedt P, Beyer B, Michl U (2017) Short- and long-term functional outcomes and quality of life after radical prostatectomy: patient-reported outcomes from a tertiary high-volume center. Eur Urol Focus 3(6):615–620

    Article  Google Scholar 

  12. Good DW, Stewart GD, Stolzenburg JU, McNeill SA (2014) Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. World J Urol 32(5):1225–1233

    Article  CAS  Google Scholar 

  13. Gershman B, Meier SK, Jeffery MM, Moreira DM, Tollefson MK, Kim SP (2017) Redefining and contextualizing the hospital volume-outcome relationship for robot-assisted radical prostatectomy: implications for centralization of care. J Urol 198(1):92–99

    Article  Google Scholar 

  14. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71(4):618–629

    Article  Google Scholar 

  15. Kessler TM, Burkhard FC, Studer UE (2007) Nerve-sparing open radical retropubic prostatectomy. Eur Urol 51(1):90–97

    Article  Google Scholar 

  16. Briganti A, Chun FKH, Salonia A, Zanni G, Scattoni V, Valiquette L (2006) Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol 49(6):1019–1026 (discussion 1026–1027)

    Article  Google Scholar 

  17. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487

    Article  Google Scholar 

  18. Gandaglia G, Fossati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA (2017) Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol 72(4):632–640

    Article  Google Scholar 

  19. Gandaglia G, Zaffuto E, Fossati N, Bandini M, Suardi N, Mazzone E (2018) Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer. BJU Int 121(3):421–427

    Article  Google Scholar 

  20. Donovan JL, Peters TJ, Abrams P, Brookes ST, de Rosette JJ, Schäfer W (2000) Scoring the short form ICSmaleSF questionnaire. International Continence Society. J Urol 164(6):1948–1955

    Article  CAS  Google Scholar 

  21. Lepor H, Kaci L, Xue X (2004) Continence following radical retropubic prostatectomy using self-reporting instruments. J Urol 171(3):1212–1215

    Article  Google Scholar 

  22. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD (August 2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  Google Scholar 

  23. Huland H, Graefen M (2015) Changing trends in surgical management of prostate cancer: the end of overtreatment? Eur Urol 68(2):175–178

    Article  Google Scholar 

  24. Pierorazio PM, Ross AE, Han M, Epstein JI, Partin AW, Schaeffer EM (2012) Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer. BJU Int 109(7):988–993

    Article  Google Scholar 

  25. Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM (2009) Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol 182(3):1126–1132

    Article  Google Scholar 

  26. Vickers AJ, Bianco FJ, Serio AM, Eastham JA, Schrag D, Klein EA (2007) The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst 99(15):1171–1177

    Article  Google Scholar 

  27. Asimakopoulos AD, Miano R, Di Lorenzo N, Spera E, Vespasiani G, Mugnier C (2013) Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon. Surg Endosc 27(11):4297–4304

    Article  Google Scholar 

  28. Patel VR, Coelho RF, Chauhan S, Orvieto MA, Palmer KJ, Rocco B (2010) Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon. BJU Int 106(5):696–702

    Article  Google Scholar 

  29. Greco F, Hoda MR, Wagner S, Reichelt O, Inferrera A, Magno C (2011) Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in 457 patients. BJU Int 108(4):583–587

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland

    Luca Afferi, Marco Moschini, Philipp Baumeister, Stefania Zamboni, Julian Cornelius, Gallus Ineichen, Agostino Mattei & Livio Mordasini

  2. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy

    Marco Moschini

  3. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy

    Stefania Zamboni

Authors
  1. Luca Afferi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Moschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Baumeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefania Zamboni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julian Cornelius
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gallus Ineichen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Agostino Mattei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Livio Mordasini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LA: project development, data management, data analysis, manuscript writing/editing. MM: project development, data collection, manuscript editing. PB: project development, data collection, manuscript editing. SZ: project development, data collection, manuscript editing. JC: data collection, manuscript editing. GI: data collection, manuscript editing. AM: project development, manuscript writing/editing: LM: project development, manuscript writing/editing.

Corresponding author

Correspondence to Luca Afferi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement on the welfare of animals and human rights

This article does not contain any studies/experiments with human participants or animals performed by any of the authors. All persons gave their informed consent to use their data (deidentified) for this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Afferi, L., Moschini, M., Baumeister, P. et al. Trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing, robot-assisted radical prostatectomy: a 10-year low-intermediate volume single-center experience. World J Urol 39, 389–397 (2021). https://doi.org/10.1007/s00345-020-03206-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03206-y

Keywords

Search

Navigation