Canadian Urological Association-Canadian Urologic Oncology Group guideline on metastatic castration-naive and castration-sensitive prostate cancer
Bibliographic record
Abstract
MethodsEmBASE and Medline databases were accessed to identify all relevant articles focused on mCNPC or mCSPC between January 2000 and August 2019 with the following key words strategy: "prostate cancer", "hormone sensitive", "castration naïve", "castration sensitive", "androgen deprivation", "chemotherapy", "androgen receptor-axis targeted therapy", and "metastatic."An expert panel comprised of urologists, medical oncologists and radiation oncologists with significant experience managing mCNPC/mCSPC was utilized to develop the recommendations.Guidelines were developed by consensus among the panel.Levels of evidence and grades of recommendation employ the WHO modified Oxford Center for Evidence-Based Medicine grading system(6).Based on a modified GRADE methodology, the strength of each recommendation is represented by the words STRONG or WEAK(6).Wherever Level 1 evidence is lacking, the guideline attempts to provide expert opinion to aid in the management of patients. Indications for staging in prostate cancerFor newly diagnosed PC, staging with CT scan of the abdomen and pelvis and bone scan (99mTc-MDP) should be performed for men with any high risk features: PSA>20 ng/mL, Gleason score >7, clinical stage T3 or greater (Level of evidence 3, Strong recommendation).Conventional imaging to stage PC includes, bone scintigraphy using technetium-99mmethylene diphosphonate (99mTc-MDP) to assess for bone metastases and abdominopelvic CT imaging to assess for lymphadenopathy and visceral metastases.In patients with high risk disease, CT imaging of the chest may also be considered as lung metastases are the most common site of visceral metastases(7).Novel diagnostic imaging to stage PC including choline-based PET/CT, fluciclovine PET/CT and PSMA-targeted PET/CT, appear to improve the sensitivity and specificity of conventional imaging; however, these tests are not universally available Canada, their clinical utility is not clear and they are still considered investigational by Health Canada.Most importantly, all of the phase 3 trials in mCNPC/mCSPC utilized conventional imaging for staging and risk determination, and conclusion were based on these.Novel imaging remains investigational. Assessment of prognosis Patients diagnosed with metastatic PC should be classified as high volume/high risk or low volume/low risk based on conventional imaging and prostate cancer biopsy for prognostication (Level of evidence 2, Weak recommendation).Utilizing data from two large mCNPC/mCSPC trials, SWOG8894 and GETUG15, possible prognostic features suggestive of worse prognosis have been identified and include: appendicular disease (defined as bone lesions in the chest, skull and/or extremities), worse performance status, prostate specific antigen greater than 65, Gleason score of 8 or greater, high
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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 | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.005 | 0.001 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.007 | 0.003 |
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".