{"entity":{"id":"paper-damico-risk-groups-jama-1998","kind":"paper","name":"D'Amico risk groups: biochemical outcome after radical prostatectomy, external beam radiotherapy or brachytherapy","aka":[],"tldr":"This analysis of nearly 1,900 men introduced the low, intermediate and high-risk groups for localised prostate cancer based on PSA, Gleason score and stage, a classification still used to choose between surveillance, surgery and radiotherapy.","summary":"Retrospective cohort study of 1,872 men treated with radical prostatectomy, external beam radiotherapy or brachytherapy, stratified into low (PSA 10 or less, Gleason 6 or less, T1c to T2a), intermediate and high (PSA over 20, Gleason 8 to 10, or T2c) risk groups by five-year PSA failure.\n\nLow-risk men had equivalent outcomes with all three treatments; intermediate- and high-risk men did worse with brachytherapy alone than with surgery or external beam radiotherapy.","asOf":"2026-09-17","links":[{"label":"JAMA 1998","url":"https://doi.org/10.1001/jama.280.11.969"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/9749478/"}],"tags":[],"related":["prostate-roadmap","paper-catalona-psa-screening-test-nejm-1991","paper-bill-axelson-spcg-4-29-year-nejm-2018"],"cancers":["prostate-high-risk","prostate-intermediate-risk","prostate-low-risk","prostate"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jama"],"dependsOn":[],"notes":[],"journal":"JAMA","year":1998,"doi":"10.1001/jama.280.11.969","pmid":"9749478","authors":"D'Amico AV, Whittington R, Malkowicz SB, et al.","paperType":"observational","findings":["Three risk groups with distinct five-year PSA failure-free survival.","Brachytherapy alone inferior for intermediate- and high-risk disease."],"whatItMeans":"The D'Amico system, refined by the NCCN, remains the framework for the very-low to very-high-risk categories used on this site's prostate pages.","caveats":["Retrospective, PSA-based endpoint; modern imaging and genomics refine the groups."],"changedPractice":true,"participants":1872},"route":"/key-papers/paper-damico-risk-groups-jama-1998/","neighbours":{"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"paper":[{"id":"paper-catalona-psa-screening-test-nejm-1991","kind":"paper","name":"Measurement of prostate-specific antigen in serum as a screening test for prostate cancer","route":"/key-papers/paper-catalona-psa-screening-test-nejm-1991/"},{"id":"paper-bill-axelson-spcg-4-29-year-nejm-2018","kind":"paper","name":"SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up","route":"/key-papers/paper-bill-axelson-spcg-4-29-year-nejm-2018/"}],"cancer":[{"id":"prostate-high-risk","kind":"cancer","name":"Localised prostate cancer, high and very high risk","route":"/cancers/prostate-high-risk/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"journal":[{"id":"jama","kind":"journal","name":"JAMA","route":"/journals/jama/"}]}}