Clinical calculator summary
Original 1998 D'Amico risk classification
Clinical calculator summary
Original 1998 D'Amico risk classification
A three-group pretreatment classification in which the worst PSA, biopsy Gleason, or clinical-stage feature determines risk.
Evidence-based context for fast calculator use
- Purpose:
- Reproduce the original post-treatment PSA-failure risk grouping for clinically localized prostate cancer.
- Population:
- Men with clinically localized cT1c-T2c prostate cancer assessed before radical prostatectomy, external-beam radiation therapy, or interstitial radiation therapy.
- Factors:
- Pretreatment PSA, Biopsy Gleason score, Clinical T stage, Worst-feature rule
- Reference:
- D'Amico et al. JAMA. 1998;280:969-974. doi:10.1001/jama.280.11.969.
D'Amico Risk Classification
Clinical Context & Background
The worst pretreatment feature determines the original 1998 D'Amico group: low only when PSA <=10 ng/mL, biopsy Gleason <=6, and cT1c/cT2a; intermediate for PSA >10 to <=20, Gleason 7, or cT2b when no high-risk feature is present; high for PSA >20, Gleason >=8, or cT2c.Reference Data
| Risk Group | Original 1998 definition | Interpretation |
|---|---|---|
| Low Risk | PSA ≤10 AND biopsy Gleason ≤6 AND cT1c/cT2a | No intermediate- or high-risk feature |
| Intermediate Risk | No high-risk feature AND PSA >10 to ≤20 OR Gleason 7 OR cT2b | Worst feature is intermediate risk |
| High Risk | PSA >20 OR biopsy Gleason ≥8 OR cT2c | Any high-risk feature controls |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use pretreatment PSA, biopsy Gleason score, and examination-based clinical stage in clinically localized cT1c-T2c disease.
- Use the raw unrounded PSA value at the 10 and 20 ng/mL boundaries.
How To Interpret
- Low risk requires all three low-risk features.
- Any high-risk feature controls; otherwise any intermediate-risk feature produces the intermediate group.
What To Do Next
- Integrate the historical group with contemporary staging, life expectancy, patient preferences, and specialist assessment.
- Do not use the group as an individualized survival estimate or treatment recommendation.
Limitations
- Not the modern NCCN, EAU, favorable-intermediate, unfavorable-intermediate, or very-high-risk extensions.
- Not applicable to cT1a/cT1b, cT3 or higher, N1/M1 disease, post-treatment PSA, or prostatectomy Gleason inputs.
Validated Population
Original 1998 cohort: clinically localized cT1c-T2c prostate cancer treated with prostatectomy, external-beam radiation, or interstitial radiation.
Threshold example
PSA 10 ng/mL, biopsy Gleason ≤6, and cT2a gives Low Risk; PSA immediately above 10 gives Intermediate Risk.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed D'Amico cases passed through visible production controls at the PSA=10 low equality and just-over-10 and just-over-20 transitions.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/prostate-cancer-damico-risk-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during the route load.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/prostate-cancer-damico-risk.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- 292/292 independent source-rule, exact-boundary, malformed-input, UI, trace, reset, and immutability checks passed.
- Original 1998 D'Amico three-group classification only; the prostate panel does not calculate D'Amico and remains In review.
: Calculation and input-contract correction
- Removed favorable defaults, coercion, extra-field acceptance, ambiguous PSA labels, and silent inclusion of unsupported stage values; exact raw PSA 10 and 20 ng/mL boundaries are enforced.
- Added source-exact worst-feature trace and restricted wording to the original post-treatment PSA-failure association without individualized survival or treatment claims.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
Is PSA exactly 10 ng/mL low or intermediate risk?
Exactly 10 ng/mL is in the low PSA category. PSA must be greater than 10 ng/mL to enter the intermediate category.
Is PSA exactly 20 ng/mL high risk?
No. Exactly 20 ng/mL remains intermediate; PSA must be greater than 20 ng/mL to be high risk.
Does this include modern favorable-intermediate or very-high-risk groups?
No. This page reproduces only the original 1998 three-group D'Amico classification.
Evidence-based oncology decision support. Verify with clinical guidelines.