D'Amico risk groups: biochemical outcome after radical prostatectomy, external beam radiotherapy or brachytherapy
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.
Overview
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.
- Three risk groups with distinct five-year PSA failure-free survival.
- Brachytherapy alone inferior for intermediate- and high-risk disease.
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.
- Retrospective, PSA-based endpoint; modern imaging and genomics refine the groups.
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