A systematic review of randomized trials in localized prostate cancer.
Bibliographic record
Abstract
INTRODUCTION: Most treatment studies of localized prostate cancer are observational in nature. The recent publication of a large randomized trial of radical prostatectomy (RP) versus watchful waiting (WW) has focused increased attention on the treatment of localized prostate cancer. We reviewed all published randomized trials that compared different primary treatment modalities for localized prostate cancer. MATERIALS AND METHODS: We performed a comprehensive Medline search from 1966 to March 2003 to identify all English-language randomized trials of RP, external-beam radiotherapy (EBRT), brachytherapy, watchful waiting, and primary androgen-deprivation therapy in localized prostate cancer. RESULTS: Nine publications dealing with four separate randomized trials were identified. Two studies examined RP and WW; one study examined RP and EBRT; one study examined RP and EBRT, with both groups receiving neoadjuvant and adjuvant androgen-deprivation therapy. WW, in both studies, refers to no treatment until palliative therapy is required. Two of the four trials, conducted in Veterans Administration medical centers, had small sample sizes and were plagued by several methodological limitations. Neither trial was able to convincingly demonstrate an advantage of RP over WW or RP over EBRT. One trial of RP versus EBRT included patients with both localized and locally advanced disease. The fourth trial demonstrated statistically significant reduction in disease-specific mortality, local progression, and development of metastases in patients with primarily clinically detected, well- or moderately well differentiated prostate cancer who underwent RP as compared to WW. CONCLUSIONS: There is high-quality evidence from one randomized trial in favor of surgery over watchful waiting with palliative intent for non-high grade localized prostate cancer. However, most tumors in this study were clinically diagnosed rather than screen-detected. Further randomized trials examining the treatment of screen-detected, localized prostate cancer are needed; several are currently underway.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.156 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.017 | 0.008 |
| Bibliometrics | 0.014 | 0.014 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".