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D'Amico Risk Classification for Prostate Cancer

5-year biochemical failure risk after localized prostate cancer therapy.

D'Amico Risk Classification for Prostate Cancer
PSA at diagnosis
ng/mL
Biopsy Gleason score
Clinical T stage
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When to use

  • Counselling and treatment selection (surveillance vs. radical therapy vs. combined-modality therapy) in clinically localized prostate cancer.

Formula

Low: PSA≤10 ng/mL AND Gleason≤6 AND stage T1c-T2a. Intermediate: PSA 10-20 ng/mL OR Gleason 7 OR stage T2b. High: PSA>20 ng/mL OR Gleason≥8 OR stage T2c-T3a. The worst single criterion determines the overall group.

Pearls and pitfalls

  • Originally derived to predict biochemical recurrence-free survival after prostatectomy, external-beam radiation, or brachytherapy.
  • Later NCCN modifications add a “very-high-risk” tier (e.g., T3b-T4 or primary Gleason pattern 5) not in the original 1998 classification.

References

  1. D'Amico AV, et al. JAMA. 1998;280(11):969-74.