Real-world management of advanced prostate cancer: A Canadian comparison of academic specialists and community-based prostate cancer physicians.
Bibliographic record
Abstract
29 Background: The Canadian GU Research Consortium recently conducted a consensus development conference with 27 academic prostate cancer (PC) specialists leading to 31 consensus recommendations. We conducted a survey to compare community-based practice with the consensus recommendations on the management of metastatic castration sensitive prostate cancer (mCSPC), metastatic castration resistant prostate cancer (mCRPC) and non-metastatic castration resistant prostate cancer (nmCRPC). Methods: An 87-item online questionnaire was sent to 600 Canadian community urologists, medical oncologists, radiation oncologists, and general practitioner oncologists involved in the treatment of PC. Results: Seventy-two physicians responded to the questionnaire (12% response). A discordance of >25% was observed in 15 of 31 recommendations (48%). Among the areas of discordance were treatment approach for patients with nmCRPC and PSADT < 10 months who are negative for metastases on conventional imaging but metastatic on PET-based imaging. Of the academic physicians, 89% indicated treating with agents approved for nmCRPC compared to 50% of community physicians (p=0.0005). Important discrepancies were also observed across academic and community physicians for radiation to the prostate for low-volume mCSPC which was 74% vs 27%, (p<0.0001) respectively; criteria for stopping therapy in mCRPC in which 78% of academic physicians favored continuation of therapy in the event of PSA progression only, compared to 24% of community physicians. Sequencing of therapy after prior apalutamide for nmCRPC using subsequent docetaxel treatment was observed in 81% of academic physicians vs 35% of community physicians, (p<0.0001), and use of genetic testing was favored by 74% of academics vs 36% of community physicians, (p<0.0001) for newly diagnosed metastatic prostate cancer. Conclusions: The areas of discordance between a national sample of community-based PC physicians and academic consensus recommendations represent potential areas for education, practice tools and future research.
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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 | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".