Impact of compliance on outcomes for patients on active surveillance for prostate cancer.
Bibliographic record
Abstract
36 Background: Active surveillance (AS) is the standard of care for low-risk prostate cancer to reduce the risk of overtreatment. However, the impact of compliance to AS on outcomes has not been well described. We hypothesized that compliance to an AS protocol and to the recommendation for active treatment would affect subsequent treatment failure. Methods: A prospective, single-arm cohort study was initiated in 1995 to assess an AS program. Triggers for intervention included a PSA doubling time of less than three years and histologic upgrade. The AS protocol was defined as PSA measurements every three months for two years and then twice annually, as well as a confirmatory biopsy within 12 months and then every three years. Compliance to the AS protocol was defined as four PSA tests and a confirmatory biopsy by 1.5 years after enrollment. Compliance to treatment was defined as the initiation of any active therapy within 12 months from the time of any trigger described above. Treatment failure was defined as a PSA > 0.2 after surgery, PSA > nadir + 2 for other treatments, or the development of metastases. Statistics were performed using logistic regression analysis and the Fisher exact test. Results: A total of 1282 patients were included in the final analysis, of which 460 received treatment. Median follow up was 7.1 years. The actuarial rate of biochemical control at five and 10 years amongst treated patients was 78% and 59% respectively. The rates of compliance to biopsy at years one, four and seven were 71%, 36% and 13%. The treatment failure rate was lower for patients compliant to the AS protocol (crude rate 28%) than those non-compliant (crude rate 38%) with an odds ratio of 0.64 (95% CI 0.43-0.94, p = 0.03). Patients compliant to the protocol were also less likely to develop metastases (OR 0.42, 95% CI 0.21-0.88, p = 0.02). There was no impact on treatment failure by adherence to active therapy within 12 months (p = 0.25) after reaching a trigger to come off AS. Conclusions: Non-compliance to an AS protocol leads to a higher risk of subsequent treatment failure and development of metastases. Physicians and patients need to work together diligently to ensure enrollment on an AS program is followed by adherence to regular PSA checks and repeat biopsies.
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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 | 0.005 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".