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.
Version: 1.28
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D'Amico risk score: points

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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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This model is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

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