Contemporary Evaluation of the D'Amico Risk Classification of Prostate Cancer
ABSTRACT 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.
- SourceAvailable from: Stefano Vagge
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- "The median age was 72 years old (range: 53–82) with an ECOG-performance status value of 0-1 . As for their risk-category (D' Amico)  "
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
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ABSTRACT: Although the popularity of robotic-assisted laparoscopic prostatectomy is assured, little is known about the oncologic outcomes following the procedure. We performed a retrospective cohort study including consecutive patients who underwent the surgery between 2003 and 2007 with at least 6 months of follow-up (n=464). Patients were stratified into low-, intermediate-, and high-risk groups according to D'Amico criteria. Biochemical failure was defined as a PSA > or =0.2 ng/mL. Of study patients, 256 (55%), 171 (37%), and 37 (8%) were classified as low-, intermediate-, and high-risk, respectively. Over a mean follow-up of 14.1 months (range, 6.0 to 55.3), 7.3% experienced biochemical failure. Biochemical disease-free survival at 30 months was 94%, 79%, and 73% among patients in the low-, intermediate-, and high-risk groups, respectively, (P<0.001). Preoperative risk stratification was strongly associated with biochemical failure, with hazard ratios of 5.04 (95%: 1.52 to 16.7; P<0.001) and 7.04 (95%: 1.39 to 35.6; P < 0.001) for intermediate- and high- over low-risk groups, respectively. The ability of risk stratification to predict biochemical failure had an area under the receiver operator characteristic curve of 0.74. Robotic prostatectomy provides excellent cancer control outcomes for clinically localized disease.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2009; 13(4):515-21. DOI:10.4293/108680809X12589998404164 · 0.79 Impact Factor
- Value in Health 11/2003; 6(6):674-674. DOI:10.1016/S1098-3015(10)61723-8 · 2.89 Impact Factor