UroToday - Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy

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Thursday, 15 May 2008

BERKELEY, CA (UroToday.com) - Dr. Boorjian and colleagues from the Mayo

Clinic validated the D'Amico risk classification of predicting survival

following radical prostatectomy (RP) using their single institution cohort

of 7,591 patients.

The patients underwent radical prostatectomy between 1987 and 2003 by

multiple surgeons, but using standardized techniques. Patients who were in

the high risk D'Amico group were older and had a greater percent of

aggressive prostate cancer at the time of radical prostatectomy including

pathological T3/4 tumors, pathological Gleason 8-10 cancer and positive

surgical margins. Over the time course of the study a stage migration was

noted between the periods 1987-1992 and 1999-2003; a decline in high-risk

patients from 34% to 14 % and an increase in low-risk patients from 22% to

55% occurred. Following radical prostatectomy 15% of patients received

adjuvant therapy. For low, intermediate and high risk patients 6%, 11%, and

24% received adjuvant androgen deprivation therapy, respectively.

At a median follow-up of 7.7 years, 1,866 of the 7,591 patients had

biochemical recurrence; 406 experienced local recurrence, 290 relapsed

systemically and 954 died including 154 deaths from prostate cancer. The

hazard ratio of death from CaP following radical prostatectomy was 11.5 for

high-risk patients and 6.3 for intermediate-risk patients compared to

low-risk patients. The authors confirmed that the D'Amico risk

classification stratified patients for each outcome measured. A further

analysis confirmed the ability for the D'Amico classification to predict

outcomes during the PSA era despite the changing distribution of risk group

stratification. The addition of surgical outcomes such as pathologic Gleason

score, stage and margin status improved the predictive ability of the model

for cancer specific survival.

Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML

J Urol. 2008 Apr;179(4):1354-60

doi 10.1016/j.juro.2007.11.061

PubMed Abstract

PMID: 18289596

blute.michael@...