Prostate Cancer Recurrence Stratification
Clinical Parameters
ng/mL
Classification Pending
Enter PSA, Gleason score, and clinical stage to determine the D'Amico Risk Group.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
When to Use D'Amico Risk Classification
Newly diagnosed, clinically localized prostate adenocarcinoma (cT1–cT3a, no evidence of nodal or distant metastasis)
Pretreatment risk stratification to estimate 5-year risk of biochemical recurrence (PSA failure) after radical prostatectomy, external beam radiotherapy (EBRT), or brachytherapy
Guiding shared decision-making for management: active surveillance vs definitive therapy vs multimodal treatment
Patient counseling on expected oncologic outcomes and intensity of follow-up
Stratification in clinical trials and research registries for localized prostate cancer
Comparison with modern tools (NCCN, EAU, CAPRA, MSKCC nomograms) — D'Amico remains a simple, widely recognized benchmark
Key Input Variables
| Variable | Description | Clinical Source | Notes |
|---|---|---|---|
| Pre-treatment PSA (ng/mL) | Serum prostate-specific antigen level | Most recent value prior to biopsy or any intervention | Use the highest value if multiple; avoid during active prostatitis or within 4–6 weeks of biopsy |
| Biopsy Gleason Score (or ISUP Grade Group) | Histologic grade from transrectal or transperineal biopsy | Systematic ± targeted cores | Original used sum; modern practice favors ISUP Grade Groups (GG1 = GS ≤6, GG2 = 3+4, GG3 = 4+3, etc.) |
| Clinical T Stage (cT) | Digital rectal exam (DRE) ± imaging (mpMRI) findings | AJCC TNM staging | cT1c (non-palpable, biopsy-detected), cT2a/b/c (palpable), cT3a (extracapsular extension suspected) |
Epidemiology and Clinical Context
Prostate cancer is the most common non-cutaneous malignancy in men. D'Amico classification, published in 1998, was developed from a cohort of 1872 men treated with radical prostatectomy, EBRT, or brachytherapy ± neoadjuvant androgen deprivation therapy (ADT). It remains one of the most cited and simplest risk tools. Approximately 30% of newly diagnosed localized cases fall into high-risk by D'Amico criteria. Low-risk disease has shifted toward active surveillance eligibility, while high-risk patients increasingly receive multimodal therapy (EBRT + long-term ADT ± brachytherapy boost or surgery + adjuvant/salvage therapies). Modern cohorts show stage migration: fewer high-risk cases at radical prostatectomy due to earlier detection, yet D'Amico still discriminates biochemical recurrence-free survival (BRFS) effectively.
Indications for Additional Workup by Risk Group
Low risk: mpMRI if not already performed; bone scan or cross-sectional imaging generally not indicated (very low metastatic risk)
Intermediate risk: mpMRI for local staging and to guide biopsy; consider PSMA-PET in select unfavorable cases; bone scan if PSA >10 or symptoms
Unfavorable intermediate or high risk: mpMRI + PSMA-PET/CT or conventional imaging (CT abdomen/pelvis + bone scan) to rule out occult metastases
Any risk with symptoms suggestive of metastasis (bone pain, weight loss, anemia) or very high PSA (>20–50 ng/mL): advanced imaging mandatory
Genetic testing (germline): consider in high-risk, family history of prostate/breast/ovarian/pancreatic cancer, or Ashkenazi Jewish ancestry
Last Comprehensive Review: 2026