Detection and tumour grading of prostate cancer in community hospitals
Notice bibliographique
Résumé
Several studies have examined the variations between community pathologists and urological pathologists with respect to the detection and Gleason grading of prostate cancer via transrectal ultrasound–guided core biopsies of the prostate gland.1 Most studies are based on American and European hospitals, thus I congratulate Newell and colleagues2 on their study examining these differences in the Canadian population. The authors found a significantly higher rate of categorical diagnosis of prostate cancer at prostate gland biopsy in community hospitals than in university hospitals (58% v. 33%). Detection secondary to case-finding can be more evident in a community where prostate cancer screening may have been delayed and can explain the higher detection rates of prostate cancer found in their study. Several other factors are known to influence the yield of prostatic biopsy in the detection of cancer, including serum prostate-specific antigen (PSA) levels, findings from digital rectal examinations (induration v. hard nodules) and age. We also know that the size of the prostate may be a factor influencing prostate cancer detection rates. In Canada, where health care is provided in a single-payer system with limited resources, community urologists may have a different threshold for biopsy compared with university urologists. Furthermore, Newell and colleagues found significant variations among community pathologists in the diagnosis and grading of prostate cancer at biopsy. Previous studies have also shown that community pathologists tend to “undergrade” prostate cancer found at biopsy.1 In the present study, the incidence of Gleason score 6 prostate cancer was 36% compared with 49% in the literature; however, without review of all prostate gland biopsies by a dedicated urological pathologist, it is not possible to determine whether community pathologists in Canada also “undergrade” prostate cancer. Factors such as the size of the prostate and the extent of prostatic biopsies have been recently shown to influence Gleason scores and the incidence of “upgrading” on prostatectomy specimens; these factors should be taken into account when evaluating this specific issue.3 In larger glands, elevated serum PSA levels (the driving factor for a biopsy) are commonly the result of benign prostatic hyperplasia that is concomitantly present when cancer is found. The cancers detected in this setting typically can be well differentiated and low in volume. I believe it is beneficial to obtain a second consultation with a urological pathologist — especially for patients with prostate cancer who are being considered for active surveillance — to ensure the absence of higher-grade disease.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».