Notice bibliographique
Résumé
The Canadian consensus meeting, held in Toronto in May 2006, represents an important initiative in sorting out much of the confusion surrounding the use of 5-alpha reductase inhibitors (5ARIs) in clinical practice. The impact of the Medical Therapy of Prostatic Symptoms study and the Prostate Cancer Prevention Trial (PCPT) are quite dramatic as they confirm that 5ARIs, a class of drugs that never gained much market share in urologic practice, have significant impact on both benign prostatic hyperplasia (BPH) and prostate cancer- related outcomes. It is quite ironic that these pivotal trials, funded not by industry but by tax payers, have come to fruition at a time when finasteride is soon to be genericized in the United States. Commercial interests aside, this consensus summary provides useful information for urologists and primary care physicians. With respect to BPH-related outcomes, the 5ARIs have clearly demonstrable benefits in reducing long-term complications and lower urinary tract symptoms (LUTS). There is little debate on this topic. The impact of 5ARIs on prostate cancer prevention remains controversial and, in my mind, these recommendations have some limitations that deserve mention. With respect to the grade and volume bias, this observation, internationally led by our group, is real, and many other centres are now reporting it. We must emphasize that these recommendations report that this bias explains the PCPT grade issue “with a high degree of confidence.” While I truly believe this is the case, a small but lingering doubt must still exist within us all. It is essentially now unprovable! Perhaps more relevant than the grade issue is the clinical significance of the prevented cancers. Indeed, in the PCPT the relative risk reduction in “for-cause” biopsies, those that mirror clinical practice, is only 10%. I believe that future pivotal trials, such as REDUCE (the Reduction by Dutasteride of Prostate Cancer Events study; dutasteride v. placebo among men with negative prostate biopsy and elevated prostate-specific antigen), will help us clarify some of these issues. With respect to class effect and use of 5ARIs, I believe that both 5ARIs are good agents and that there are theoretical advantages to dutasteride in cancer prevention. Further trials will bear this out. What are clinicians to do? Consider the cancer prevention properties as an added benefit to complication reduction and symptom improvement for men with large-volume BPH and LUTS. In my view, either 5ARI is appropriate. Consider primary prevention with 5-ARI in ultra-high risk men, those in whom a cancer is likely to be clinically significant (e.g., men with strong family history, African-Canadians or both). In this setting, the best evidence would support the use of finasteride.
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 | 0,006 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,005 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,014 | 0,004 |
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 ».