title: Evaluation of D'Amico criteria for low-risk prostate cancer.
abstract: OBJECTIVE
  The aim of the study was to identify the risk of unfavourable disease (≥ pT3 and/or Gleason score ≥ 7) in radical prostatectomy (RP) specimens and biochemical progression-free survival (BPFS) after RP in patients with low-risk prostate cancer detected by D'Amico criteria before surgery.
  
  
  METHODS
  Between 2004 and 2007, 690 men underwent prostate biopsy and RP at a single university hospital. Of those, 248 patients (35.9%) had low-risk prostate cancer criteria. The endpoints of the study were detection of low-risk (pT2 and Gleason score ≤ 6) or unfavourable (≥ pT3 and/or Gleason score ≥ 7) prostate cancer, and BPFS. The risk of progression was analysed using multivariate Cox regression model and BPFS was established using Kaplan-Meier analysis.
  
  
  RESULTS
  The median follow-up was 60 months (1-112 months). pT3 was detected in 14.1%, and Gleason score ≥ 7 in 32.7% of patients. Unfavourable prostate cancer was detected in 37.5% of patients. Overall biochemical relapse rate was 13.6%. The estimated probability of 3-, 5- and 8-year BPFS for all study patients was 90.6%, 88.1% and 77.9%, respectively. Eight-year BPFS was 83.3% for low-risk prostate cancer and 68.2% for unfavourable prostate cancer (p = 0.007). Positive surgical margins (p = 0.0001) and postoperative Gleason score (p = 0.023) were the most significant predictors of biochemical relapse in Cox regression analysis.
  
  
  CONCLUSIONS
  The D'Amico criteria may underestimate potentially aggressive prostate cancer in up to 37.5% of patients. Consequently, caution is recommended when the decision concerning the treatment modality is based on D'Amico criteria alone.
authors: Departments of 1Urology.
authors: Daimantas
authors: D
authors: Milonas
authors: Marius
authors: M
authors: Kinčius
authors: Giedrius
authors: G
authors: Skulčius
authors: Aivaras Jonas
authors: AJ
authors: Matjošaitis
authors: Inga
authors: I
authors: GudinavičienĖ
authors: Mindaugas
authors: M
authors: Jievaltas
mesh_terms: D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: D'Amico criteria; low-risk prostate cancer; radical prostatectomy