Contemporary Evaluation of the D'Amico Risk Classification of Prostate Cancer

Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Urology (Impact Factor: 2.19). 12/2007; 70(5):931-5. DOI: 10.1016/j.urology.2007.08.055
Source: PubMed


In 1998, D'Amico et al. suggested a model stratifying patients with prostate cancer into those with low, intermediate, or high-risk of biochemical recurrence after surgery according to the clinical TNM stage, biopsy Gleason score, and preoperative prostate-specific antigen level. We studied the performance and clinical relevance of this classification system over time, in the context of the stage migration seen in the contemporary era, using data from a high-volume, tertiary referral center.
From 1984 to 2005, 6652 men underwent radical prostatectomy at our institution for clinically localized prostate cancer (clinical Stage T1c-T2c) with follow-up information available and no neoadjuvant or adjuvant therapy before biochemical recurrence. Biochemical recurrence-free survival (BRFS) was estimated using the Kaplan-Meier method, and the BRFS rates between the D'Amico risk groups and by era were compared using the log-rank statistic. Finally, the distribution of patients among the three groups was compared over time.
The 5-year 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). In the contemporary era, a very small fraction (4.9%) of patients undergoing radical prostatectomy at our institution were in the high-risk group, with most (67.7%) in the low-risk group (P <0.001).
The D'Amico classification system continues to stratify men into risk groups with statistically significant differences in BRFS. However, the major shift in the distribution of patients among the three risk groups over time suggests that the clinical relevance of this classification scheme may be limited and diminishing in the contemporary era.

36 Reads
  • Source
    • "The median age was 72 years old (range: 53–82) with an ECOG-performance status value of 0-1 [16]. As for their risk-category (D' Amico) [17] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment. Material and methods: Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. Results: Most of patients (83%) did not develop acute gastrointestinal (GI) toxicity and 50% did not present genitourinary (GU) toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL) of the conventionally treated cohort (P = 0.02). Conclusions: Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.
    03/2014; 2014:541847. DOI:10.1155/2014/541847
  • Source
    • "We compared our results with the clinicopathological parameters of Westerners collected in large-scale series including the Prostate Strategic Urological Research Endeavor (CaPSURE) databases, SEARCH databases and a large retrospective Western study.11-13 Western series showed younger age and lower PSA levels compared to the groups in our study (p<0.001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations. We retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months. Group 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores ≤6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores ≤6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores ≤6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series. Korean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.
    Yonsei medical journal 05/2012; 53(3):543-9. DOI:10.3349/ymj.2012.53.3.543 · 1.29 Impact Factor
  • Source
    • "D’Amico risk stratification of prostate cancer2 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Widespread screening with prostate-specific antigen (PSA) has led to a significant increase in the detection of early stage, clinically localized prostate cancer (CaP). Various treatment options for localized CaP are discussed in this review article including active surveillance, radical prostatectomy, radiation therapy, and cryotherapy. The paucity of high-level evidence adds a considerable amount of controversy when choosing the "optimal" intervention, for both the treating physician and the patient. The long time course of CaP intervention outcomes, combined with continuing modifications in treatments, further complicate the matter. Lacking randomized trials that compare treatment options, this review article attempts to summarize the different treatment options and associated side-effects, including effects on health-related quality of life, from current published literature.
    Clinical Interventions in Aging 08/2010; 5:187-97. · 2.08 Impact Factor
Show more