Commentary on Preliminary clinical practice of radical prostatectomy without preoperative biopsy
Notice bibliographique
Résumé
Since Xing et al[1] first proposed radical prostatectomy (RP) without preoperative biopsy for patients with highly suspicious prostate cancer identified by multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) in 2019, several original articles have reported attempts in this direction by various independent teams. Despite sparking widespread debate, these articles and discussions have provided new insights into the diagnostic and treatment paradigms for prostate cancer. Recently, Xing’s team updated their result in the Chinese Medical Journal. A series of 56 patients with standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) score of ≥4 lesions underwent RP without prior biopsy. Postoperative pathology revealed that one patient (1.8%) was diagnosed with benign disease (high-grade prostatic intraepithelial neoplasia), while six patients (10.7%) were confirmed to have clinically insignificant prostate cancer (International Society of Urological Pathology [ISUP] grade <2). These false-positive results underscore the importance of careful patient selection within this biopsy-free pathway. According to the authors’ protocol, evaluating the cut-off of SUVmax to 7.5 could eliminate these false-positive results. It is essential to note that a risk stratification system for prostate cancer based on mpMRI and PSMA PET is currently lacking, leaving the optimal cut-off values for PI-RADS score and SUVmax that accurately diagnose clinically significant prostate cancer without false positives unclear. Although preoperative biopsy remains the current standard process prior to RP and is considered essential in the urologic community, clinical practice has shown that for several malignancies, such as renal cell carcinoma and lung cancer, preoperative biopsy is not routinely necessary and treatment typically proceeds based on imaging. The commonality among these tumors lies in the sufficiently high accuracy of imaging-based diagnosis. The development of next-generation imaging may pave the way for omitting unnecessary biopsies in prostate cancer, at least for some patients. Furthermore, the recent reports on RP without preoperative biopsy may also reflect the genuine needs of certain patients. Fear of potential malignancies drives a small subset of patients to accept the risk of no cancer after surgery rather than spend several weeks in the traditional biopsy driven process along with the well-known associated potential adverse events of prostate biopsy. It is important to acknowledge the limitations in the current study including the retrospective nature, small numbers of patients all of whom had significant preexisting erectile dysfunction and a relatively high median preoperative prostate specific antigen (PSA) level of 21. Nonetheless for appropriately selected patients, this approach could be a new paradigm for prostate cancer diagnosis and treatment. In conclusion, reports such as this have raised important questions regarding prostate cancer diagnosis. Currently, prostate biopsy remains a necessary step before RP. Larger prospective clinical trials to define strict inclusion criteria are required to provide the necessary evidence in support of an imaging-based approach to prostate cancer diagnosis. Conflicts of interest None.
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 | 0,016 | 0,146 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,006 |
| Communication savante | 0,006 | 0,009 |
| Science ouverte | 0,007 | 0,003 |
| Intégrité de la recherche | 0,046 | 0,057 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,010 |
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 ».