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

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UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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