# D'Amico risk groups: biochemical outcome after radical prostatectomy, external beam radiotherapy or brachytherapy

Source: https://onco.cc/key-papers/paper-damico-risk-groups-jama-1998/  
OnCo record `paper-damico-risk-groups-jama-1998` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

This analysis of nearly 1,900 men introduced the low, intermediate and high-risk groups for localised prostate cancer based on PSA, Gleason score and stage, a classification still used to choose between surveillance, surgery and radiotherapy.

## Summary

Retrospective cohort study of 1,872 men treated with radical prostatectomy, external beam radiotherapy or brachytherapy, stratified into low (PSA 10 or less, Gleason 6 or less, T1c to T2a), intermediate and high (PSA over 20, Gleason 8 to 10, or T2c) risk groups by five-year PSA failure.

Low-risk men had equivalent outcomes with all three treatments; intermediate- and high-risk men did worse with brachytherapy alone than with surgery or external beam radiotherapy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: JAMA
- Year: 1998
- DOI: 10.1001/jama.280.11.969
- Authors: D'Amico AV, Whittington R, Malkowicz SB, et al.
- Findings: Three risk groups with distinct five-year PSA failure-free survival.; Brachytherapy alone inferior for intermediate- and high-risk disease.
- What it means: The D'Amico system, refined by the NCCN, remains the framework for the very-low to very-high-risk categories used on this site's prostate pages.
- Caveats: Retrospective, PSA-based endpoint; modern imaging and genomics refine the groups.

## Sources

- JAMA 1998: https://doi.org/10.1001/jama.280.11.969
- PubMed: https://pubmed.ncbi.nlm.nih.gov/9749478/

## Connected records

- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/)
- journals: [JAMA](https://onco.cc/journals/jama/)

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