Notice bibliographique
Résumé
In Reply.—We thank you for your interest in our study dealing with the problem of no residual cancer (“vanishing cancer”) on radical prostatectomy after 10-core biopsy.1 Indeed, you confirm that the incidence of these cases is creeping up, despite their relatively low number in current practice. You postulate that the change in current urology practice toward surgically treating more patients with organ-confined disease than in the past has also contributed to the increase of low-volume or no residual cancer cases on prostatectomy. While some urologists may be more selective now than previously with patients who are treated with prostatectomy, we believe that this simply reflects urologists' adjustment to current clinical practice that has been altered by other factors. It is well documented that the patients currently treated with radical prostatectomy are younger and have a lower incidence of advanced-stage disease and less nodal and seminal vesicle involvement than 2 decades ago.2 Epstein3 has found that 26% to 29% of the radical prostatectomies performed at The Johns Hopkins Hospital contained potentially insignificant cancers. These trends highlight that we are detecting prostate cancer at an earlier stage. This shift in the stage of detected disease has resulted from more vigilant testing and screening for serum prostate-specific antigen and increased public awareness during the last 15 years.Additionally, some investigators have recently argued in favor of lowering the prostate-specific antigen cutoff from 4.0 to 2.5 ng/mL, particularly in younger men, which may have also contributed to the growing biopsy lists in our clinics.4 After 2000, extended prostate biopsies with 8, 10, or more biopsy cores (vs 6, which had been routine during the 1990s) have become the norm in many institutions, including ours. The extended biopsy sampling strategies (from 6–12 cores) have increased the overall detection rates and have likely resulted in detection of cancer at an earlier stage.5 Our study documented higher incidence of vanishing cancer after 10-core biopsy than previously reported for studies using 6-core biopsies. However, it is still controversial whether the increased biopsy strategies have independently increased the current rates of clinically insignificant and vanishing cancers.In summary, we believe that the trend of finding no cancer on prostatectomy has been driven not by the selection of the patient population for surgery but by the widespread prostate-specific antigen testing that has resulted in disease stage-shift during the last 2 decades.
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 | 0,004 | 0,038 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,023 | 0,029 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,049 | 0,039 |
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 ».