medigraphic.com
Organo Oficial de la Sociedad Mexicana de Urología

2025, Number 4

<< Back Next >>

Rev Mex Urol 2025; 85 (4)

Evaluation of pentafecta in patients with high and very high risk prostate cancer: comparison between laparoscopic radical prostatectomy and open prostatectomy

Izunza-Laisequilla AS, Ochoa-Sánchez A, Puga-Ortega E, L’Gamiz-Moreno A, Vázquez-Niño C, Gaytán-Benitez D, Reyes-Aquart A, Castro-Fletes D, Noyola-Ávila I, Leal-Monarres AK, Canto P

Language: Spanish
References: 23
Page: 1-12
PDF size: 622.57 Kb.


ABSTRACT

Introduction: prostate cancer (PCa) is the most frequently diagnosed malignancy in men worldwide. Approximately 15 % of cases present as high or very high risk, for which the optimal surgical approach remains controversial. The pentafecta has been proposed as a key indicator of surgical success, integrating oncological and functional outcomes. This study aimed to compare 12-month pentafecta outcomes between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) in patients with high and very high-risk PCa.
Material and methods: a retrospective observational study was conducted from 2021 to 2024, including 25 patients with localized high or very high-risk PCa who underwent ORP or LRP with extended pelvic lymphadenectomy. Clinical, pathological, and functional variables were analyzed. Comparisons were made using Chi-square, Student’s t-test, or Mann-Whitney U test, according to data distribution. A p-value ‹ 0.05 was considered statistically significant.
Results: of the 25 patients, 12 underwent ORP and 13 underwent LRP. The overall pentafecta rate was 36 %. ORP showed a higher rate (50 %) compared to LRP (23 %) (p=0.061). ORP was associated with better biochemical control (p=0.023), fewer perioperative complications (p=0.054), and better erectile function outcomes (p=0.005). Urinary continence rates were similar between groups (p=0.317).
Conclusions: we did not find statistically significant differences in the global pentafecta evaluation; however, the ORP showed important clinical differences in comparison to LRP.


REFERENCES

  1. Sung H, Ferlay J, Siegel RL, LaversanneM, Soerjomataram I, Jemal A, et al. GlobalCancer Statistics 2020: GLOBOCAN Estimatesof Incidence and Mortality Worldwide for 36Cancers in 185 Countries. CA: a cancer journalfor clinicians. 2021;71(3): 209–249. https://doi.org/10.3322/caac.21660.

  2. Instituto Mexicano del Seguro Social. Protocolode Atención Integral .Cáncer de Próstata. 2023.

  3. Miyahira AK, Zarif JC, Coombs CC, FlavellRR, Russo JW, Zaidi S, et al. Prostate cancerresearch in the 21st century; report from the2021 Coffey-Holden prostate cancer academymeeting. The Prostate. 2022;82(2): 169–181.https://doi.org/10.1002/pros.24262.

  4. National Comprehensive Cancer Network.Clinical Practice Guidelines in Oncology: ProstateCancer. 2025.

  5. Goldberg H, Baniel J, Yossepowitch O. Defininghigh-risk prostate cancer. Current Opinion inUrology. 2013;23(4): 337–341. https://doi.org/10.1097/MOU.0b013e328361dba6.

  6. Hussain M, Lin D, Saad F, Vapiwala N, ChapinBF, Sandler H, et al. Newly Diagnosed High-RiskProstate Cancer in an Era of Rapidly EvolvingNew Imaging: How Do We Treat? Journal ofClinical Oncology: Official Journal of the AmericanSociety of Clinical Oncology. 2021;39(1): 13–16.https://doi.org/10.1200/JCO.20.02268.

  7. Gillessen S, Bossi A, Davis ID, De Bono J,Fizazi K, James ND, et al. Management ofPatients with Advanced Prostate Cancer. Part I:Intermediate-/High-risk and Locally AdvancedDisease, Biochemical Relapse, and Side Effectsof Hormonal Treatment: Report of the AdvancedProstate Cancer Consensus Conference 2022.European Urology. 2023;83(3): 267–293.https://doi.org/10.1016/j.eururo.2022.11.002.

  8. Salomon L, Saint F, Anastasiadis AG, Sebe P,Chopin D, Abbou CC. Combined reporting ofcancer control and functional results of radicalprostatectomy. European Urology. 2003;44(6):656–660. https://doi.org/10.1016/j.eururo.2003.09.009.

  9. Patel VR, Abdul-Muhsin HM, Schatloff O,Coelho RF, Valero R, Ko YH, et al. Criticalreview of ‘pentafecta’ outcomes after robotassistedlaparoscopic prostatectomy in highvolumecentres. BJU international. 2011;108(6Pt 2): 1007–1017. https://doi.org/10.1111/j.1464-410X.2011.10521.x.

  10. Srougi V, Bessa J, Baghdadi M, Nunes-SilvaI, da Costa JB, Garcia-Barreras S, et al.Surgical method influences specimen marginsand biochemical recurrence during radicalprostatectomy for high-risk prostate cancer:a systematic review and meta-analysis. WorldJournal of Urology. 2017;35(10): 1481–1488.https://doi.org/10.1007/s00345-017-2021-9.

  11. Adam M, Tennstedt P, Lanwehr D, Tilki D,Steuber T, Beyer B, et al. Functional Outcomesand Quality of Life After Radical ProstatectomyOnly Versus a Combination of Prostatectomywith Radiation and Hormonal Therapy.European Urology. 2017;71(3): 330–336.https://doi.org/10.1016/j.eururo.2016.11.015.

  12. Emam A, Hermann G, Attwood K, Ji W, JamesG, Kuettel M, et al. Oncologic outcome of radicalprostatectomy versus radiotherapy as primarytreatment for high and very high risk localizedprostate cancer. The Prostate. 2021;81(4): 223–230. https://doi.org/10.1002/pros.24089.

  13. Avery K, Donovan J, Peters TJ, Shaw C, GotohM, Abrams P. ICIQ: a brief and robust measurefor evaluating the symptoms and impactof urinary incontinence. Neurourology andUrodynamics. 2004;23(4): 322–330. https://doi.org/10.1002/nau.20041.

  14. Rosen RC, Cappelleri JC, Smith MD, LipskyJ, Peña BM. Development and evaluationof an abridged, 5-item version of theInternational Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.International Journal of Impotence Research.1999;11(6): 319–326. https://doi.org/10.1038/sj.ijir.3900472.

  15. Dindo D, Demartines N, Clavien PA.Classification of surgical complications: a newproposal with evaluation in a cohort of 6336patients and results of a survey. Annals ofSurgery. 2004;240(2): 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

  16. Wang Z, Ni Y, Chen J, Sun G, Zhang X, ZhaoJ, et al. The efficacy and safety of radicalprostatectomy and radiotherapy in high-riskprostate cancer: a systematic review and metaanalysis.World Journal of Surgical Oncology.2020;18(1): 42. https://doi.org/10.1186/s12957-020-01824-9.

  17. Gillessen S, Bossi A, Davis ID, de Bono J,Fizazi K, James ND, et al. Management ofPatients with Advanced Prostate Cancer. Part I:Intermediate-/High-risk and Locally AdvancedDisease, Biochemical Relapse, and Side Effectsof Hormonal Treatment: Report of the AdvancedProstate Cancer Consensus Conference 2022.European Urology. 2023;83(3): 267–293.https://doi.org/10.1016/j.eururo.2022.11.002.

  18. Bastian PJ, Gonzalgo ML, Aronson WJ, TerrisMK, Kane CJ, Amling CL, et al. Clinical andpathologic outcome after radical prostatectomyfor prostate cancer patients with a preoperativeGleason sum of 8 to 10. Cancer. 2006;107(6):1265–1272. https://doi.org/10.1002/cncr.22116.

  19. Matulay JT, DeCastro GJ. Radical Prostatectomyfor High-risk Localized or Node-PositiveProstate Cancer: Removing the Primary. CurrentUrology Reports. 2017;18(7): 53. https://doi.org/10.1007/s11934-017-0703-x.

  20. Chang K, Qin XJ, Zhang HL, Dai B, Zhu Y,Shi GH, et al. Comparison of two adjuvanthormone therapy regimens in patients withhigh-risk localized prostate cancer afterradical prostatectomy: primary results of studyCU1005. Asian Journal of Andrology. 2016;18(3):452–455. https://doi.org/10.4103/1008-682X.160884.

  21. Jazayeri SB, Weissman B, Samadi DB. Outcomesfollowing robotic-assisted laparoscopicprostatectomy: Pentafecta and Trifectaachievements. Minerva Urology and Nephrology.2018;70(1). https://doi.org/10.23736/S0393-

  22. 2249.17.02909-5.22. Boorjian SA, Karnes RJ, Rangel LJ, BergstralhEJ, Blute ML. Mayo Clinic Validation of theD’Amico Risk Group Classification for PredictingSurvival Following Radical Prostatectomy.Journal of Urology. 2008;179(4): 1354–1361.https://doi.org/10.1016/j.juro.2007.11.061.

  23. Cao L, Yang Z, Qi L, Chen M. Robot-assistedand laparoscopic vs open radical prostatectomyin clinically localized prostate cancer:perioperative, functional, and oncologicaloutcomes: A Systematic review and metaanalysis.Medicine. 2019;98(22): e15770. https://doi.org/10.1097/MD.0000000000015770.




2020     |     www.medigraphic.com