D’Amico Prostate Cancer Risk Calculator

Determines prostate neoplasm recurrence based on PSA, Gleason score and cancer stage.

In the text below the tool there is more information on the variables taken into account, the result interpretation and the original study.


The D’Amico prostate cancer risk calculator evaluates the risk of prostate neoplasm recurrence before or after localized treatment.

It is based on the prostate-specific antigen (PSA), Gleason score and on the prostate cancer staging (T-score).


The original study involved a cohort of 1872 men treated for localized adenocarcinoma of the prostate who underwent radical prostatectomy or implant with or without neoadjuvant androgen deprivation therapy.

Based on the risk calculation method, the patients have been divided in the following risk categories:

■ Low-risk patients (stage T1c, T2a and PSA level ≤10 ng/mL and Gleason score ≤6);

■ Intermediate-risk patients (stage T2b or Gleason score of 7 or PSA level >10 and ≤20 ng/mL);

■ High-risk patients (stage T2c or PSA level >20 ng/mL or Gleason score ≥8).


1

PSA level

2

Gleason Score

3

Clinical stage

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

D’Amico risk clasification explained

The D’Amico risk clasification allows clinicians to make informed treatment decisions regarding cancer recurrence, in the case of patients who are about to undergo or have underwent treatment of prostate cancer.

The following table introduces the scoring method:

D’Amico variable 1 point 2 points 3 points
PSA <10 ng/mL 10 - 20 ng/mL >20 ng/mL
Gleason ≤6 7 ≥8
Clinical stage T1 - T2a T2b T2c - T3a

Raised levels of the prostate-specific antigen (PSA) are usually indicative of malignancy, however, this indicator cannot be used as sole diagnosis.

The Gleason score represents the score of the biopsy (primary or secondary) and is based on the architectural pattern on the glands and the degree in which the cells from the sample resemble normal cells.

The clinical TNM T staging indicates how large and spread the prostate neoplasm is. T1 tumors are small, T2 tumors are larger and are differentiated in T2a, T2b and T2c, depending on how they are localized in the gland. T3 stage tumors spread through the glandular capsule.

The UCSF-CAPRA score is another prostate cancer risk model which is based on research by the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE).

 

Result interpretation

There are three risk categories, as follows:

■ Low risk patients have: PSA less than or equal to 10 ng/mL, a Gleason score less than or equal to 6 and a clinical stage T1-2a. In this case, the prostate neoplasm is growing at a slow rate. This is unlikely to spread to other tissues in the following years. However, even in this case, monitoring through frequent ultrasounds, imagistic methods or biopsies, is still recommended.

■ Intermediate risk patients have: PSA between 10 and 20 ng/mL, a Gleason score of 7 and clinical stage T2b. However, cases in which the clinical stage is T1-2a but the PSA is between 10 and 20, regardless of Gleason being lower than 7 or 7 still enter in this category. The prostate cancer is growing at a moderate rate and even in this case, is unlikely to spread in the following years. In complex cases, medication, radiation therapy or surgery may still be required.

■ High risk patients have: PSA more than 20 ng/mL, a Gleason score equal or larger than 8 or clinical stage T2c, T3a. Similar to the intermediate risk category, when any of the above three is present, regardless of the situation with the other two, the patient fits in the high risk category. In this case, the glandular tissue has changed architecture with poorly differentiated cells that are loosing their normal function. The neoplasm is likely to spread in the following years.

 

About the study

The score has been developed by D’Amico et al. following a study on 1872 men treated for localized adenocarcinoma of the prostate between January 1989 and October 1997.

The majority (1654) have underwent radical prostatectomy (RP) while the rest (218) underwent implant with or without neoadjuvant androgen deprivation therapy.

The main outcome measure was actuarial freedom from PSA failure (defined as PSA outcome). The study defined the risk categories as follows:

■ Low-risk patients (stage T1c, T2a and PSA level ≤10 ng/mL and Gleason score ≤6);

■ Intermediate-risk patients (stage T2b or Gleason score of 7 or PSA level >10 and ≤20 ng/mL);

■ High-risk patients (stage T2c or PSA level >20 ng/mL or Gleason score ≥8).

Low-risk patients were found to have estimates of 5-year PSA outcome after treatment with RP, RT, or implant with or without neoadjuvant androgen deprivation.

 

Original source

D’Amico AV, Whittington R, Malkowicz S, et al. Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer. JAMA. 1998; 280(11):969-974.

Validation

Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML. Mayo Clinic validation of the D’Amico risk group classification for predicting survival following radical prostatectomy. J Urol. 2008; 179(4):1354-60.

Other references

1. Hernandez DJ, Nielsen ME, Han M, Partin AW. Contemporary evaluation of the D’Amico risk classification of prostate cancer. Urology. 2007; 70(5):931-5.

2. Rodrigues G. et al. Pre-treatment risk stratification of prostate cancer patients: A critical review. Can Urol Assoc J. 2012; 6(2): 121–127.


App Version: 1.0.1

Coded By: MDApp

Specialty: Urology

System: Urinary

Objective: Evaluation

Type: Calculator

No. Of Criteria: 3

Year Of Study: 1998

Article By: Denise Nedea

Published On: April 12, 2017 · 08:56 AM

Last Checked: April 12, 2017

Next Review: April 12, 2018