Pathological Outcome in Men with Prostate Cancer Suitable for Active Surveillance after Radical Prostatectomy
Bibliographic record
Abstract
Background: Active surveillance (AS) as a treatment option for low risk prostate cancer is gaining recognition. We evaluate the validity of the AS protocol in our patient population, by defining the risk of undergrading and understaging in their pathology. We also aim to determine more accurate inclusion criteria, in order to improve the prediction of early low risk prostate cancer. Materials and Methods: Data was taken from our institutional prostate cancer registry for all men who underwent radical prostatectomy (RP) between Jan 2000 and June 2009. We determined if any of the patients would have met the University of Toronto's (UoT) AS inclusion criteria and examined their post-operative pathology. The primary end-point was pathological upgrading and upstaging. The individual inclusion factors i.e. preoperative PSA, were tested for statistical significance and better cutoffs. Univariate, multivariate and ROC curves were used in the statistical analysis. Results: 216 RPs were performed between January 2000 and June 2009. We identified 79 men who fulfilled the UoT AS criteria. 35% of patients had a Gleason score upgrade from biopsy to surgery, and 21.5% of patients had an upstage to T3 disease. Overall, 34 (43%) patients had an unfavourable change in the grade and/or stage of their prostate cancer. Conclusions: There is a significant risk of undergrading and understaging with the current criteria used for AS. There is a need to identify more discriminative AS criteria before it can be offered as an option to patients with clinically early prostate cancer.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".