D'Amico risk classification for prostate cancer
This model calculates the 5 year risk of treatment failure based on clinical factors.
Research authors: D'Amico AV, Whittington R, Malkowicz S, Schulz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, and Wein A.
Details Formula Study characteristics Files & References
★★★★
Model author
Model ID
300
Version
1.28
Revision date
2017-01-16
Specialty
MeSH terms
  • Cancer of Prostate
  • Treatment Failure
  • Gleason Score
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    Between January 1989 and October 1997, 1872 men with clinically localized prostate cancer underwent definitive local therapy. Local therapy received was radical prostatectomy (n=888) or implant with or without neoadjuvant androgen deprivation therapy (n=218) at the Hospital of the University of Pennsylvania, Philadelphia, or conformal radiotherapy (n=766) at the Joint Center for Radiation Therapy, Boston, Mass.

    Model development:
    In order to have the multivariable analysis results of the Cox proportional hazards regression model be applicable in the clinical setting for an individual patient, risk groups were defined. These risk groups were established from a review of the literature and were based on the known prognostic factors: PSA level, biopsy Gleason score, and 1992 AJCC T stage.

    Study Population

    Total population size: 1872
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Categorical characteristics

    Name Subset / Group Nr. of patients
    PSA (ng/ml) for radical prostatectomy group PSA 0-4 ng/ml 85
    PSA 4.1-10 ng/ml 510
    PSA 10.1-20 ng/ml 210
    PSA >20 ng/ml 83
    PSA (ng/ml) for external beam radiation therapy group PSA 0-4 ng/ml 77
    PSA 4.1-10 ng/ml 329
    PSA 10.1-20 ng/ml 198
    PSA >20 ng/ml 162
    PSA (ng/ml) for interstitial radiation group PSA 0-4 ng/ml 5
    PSA 4.1-10 ng/ml 37
    PSA 10.1-20 ng/ml 16
    PSA >20 ng/ml 8
    PSA (ng/ml) for interstitial radiation plus neoadjuvant androgen deprivation therapy PSA 0-4 ng/ml 16
    PSA 4.1-10 ng/ml 111
    PSA 10.1-20 ng/ml 24
    PSA >20 ng/ml 1
    Gleason score for radical prostatectomy group 2-4 164
    5-6 517
    7 133
    8-10 74
    Gleason score for external beam radiation therapy group 2-4 109
    5-6 376
    7 192
    8-10 89
    Gleason score for interstitial radiation group 2-4 6
    5-6 47
    7 10
    8-10 3
    Gleason score for interstitial radiation plus neoadjuvant androgen deprivation therapy group 2-4 10
    5-6 110
    7 29
    8-10 3
    American Joint Commission on Cancer Staging T- stage for radical prostatectomy group T1c 256
    T2a 388
    T2b 93
    T2c 151
    American Joint Commission on Cancer Staging T- stage for external beam radiation therapy group T1c 222
    T2a 246
    T2b 141
    T2c 157
    American Joint Commission on Cancer Staging T- stage for interstitital radiation group T1c 15
    T2a 35
    T2b 5
    T2c 11
    American Joint Commission on Cancer Staging T- stage for interstitial radiation plus neoadjuvant androgen deprivation therapy group T1c 57
    T2a 68
    T2b 7
    T2c 20

    D'Amico risk score:
    ...
    points

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    Result
    Note
    Notes are only visible in the result download and will not be saved by Evidencio

    D'Amico risk score: points

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    Outcome stratification

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    Conditional information

    Result interpretation


    Original study:
    In the original study population of 1872 patients (D'Amico et al, 1998), low-risk patients had estimates of 5-year prostate-specific antigen (PSA) outcome after treatment with radical prostatectomy, external beam radiation, or implant with or without neoadjuvant androgen deprivation that were not statistically different. Intermediate- and high-risk patients treated with radical prostatectomy or radiotherapy did better then those treated by implant. Prospective randomized trials are needed to verify these findings.

    Validation studies:
    In a validation study by Hemandez et al (2007) including 6,652 men, the 5-year biochemical recurrence-free survival (BRFS) rate was 84.6% overall and 94.5%, 76.6%, and 54.6% for the low, intermediate, and high-risk groups, respectively (P <0.0001).

    Boorjian et al (2008) performed a validation study including 7,591 men. The hazard ratio of death from prostate cancer after surgery in patients with high or intermediate risk disease was 11.5 (95% CI 5.9 to 22.3, P <0.0001) and 6.3 (95% CI 3.3 to 12.3, P <0.0001), respectively, compared to patients at low risk.



    Note: Patients with AJCC clinical stage T1a, T1b were not managed using implant therapy because of the significant rate or urinary incontinence noted using this approach in patients with a history of a transurethral resection of the prostate. Therefore, patients with AJCC clinical stage T1a, T1b disease managed with RP or RT were excluded from the study to ensure statistically valid comparisons.
     

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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