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
Related Scores in Practice
In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Aast Bladder Injury Scale, Aast Renal Injury Scale, Aast Urethral Injury Scale, Fourniers Gangrene Severity Index, or the Pelvic Fracture Classification to formulate a comprehensive care plan.
Last Comprehensive Review: 2026