The association of the type and number of D’Amico high-risk criteria with rates of pathologically non-organ-confined prostate cancer

INTRODUCTION: The aim of this study was to assess the association between the type and number of D’Amico high-risk criteria (DHRCs) with rates of pathologically non-organ-confined (NOC) prostate cancer in patients treated with radical prostatectomy (RP) and pelvic lymphadenectomy (PLND). MATERIAL AND METHODS: In the Surveillance, Epidemiology, and End Results database (2004–2016), we identified 12961 RP and PLDN patients with at least one DHRC. We relied on descriptive statistics and multivariable logistic regression models. RESULTS: Of 12 961 patients, 6135 (47%) exclusively harboured biopsy Gleason score (GS) 8–10, 3526 (27%) had clinical stage ≥T2c, and 1234 (9.5%) had prostate-specific antigen (PSA) >20 ng/mL. Only 1886 (15%) harboured any combination of 2 DHRCs. Finally, all 3 DHRCs were present in 180 (1.4%) patients. NOC rates increased from 32% for clinical T stage ≥T2c to 49% for either GS 8–10 only or PSA >20 ng/mL only and to 66–68% for any combination of 2 DHRCs, and to 84% for respectively all 3 DHRCs, which resulted in a multivariable logistic regression OR of 1.00, 2.01 (95% CI 1.85–2.19; p <0.001), 4.16 (95% CI 3.69–4.68; p <0.001), and 10.83 (95% CI 7.35–16.52; p <0.001), respectively. CONCLUSIONS: Our study indicates a stimulus-response effect according to the type and number of DHRCs. Hence, a formal risk-stratification within high-risk prostate cancer patients should be considered in clinical decision-making.