Bibliographic record
Abstract
In Reply.—We thank you for your interest in our study dealing with the problem of no residual cancer (“vanishing cancer”) on radical prostatectomy after 10-core biopsy.1 Indeed, you confirm that the incidence of these cases is creeping up, despite their relatively low number in current practice. You postulate that the change in current urology practice toward surgically treating more patients with organ-confined disease than in the past has also contributed to the increase of low-volume or no residual cancer cases on prostatectomy. While some urologists may be more selective now than previously with patients who are treated with prostatectomy, we believe that this simply reflects urologists' adjustment to current clinical practice that has been altered by other factors. It is well documented that the patients currently treated with radical prostatectomy are younger and have a lower incidence of advanced-stage disease and less nodal and seminal vesicle involvement than 2 decades ago.2 Epstein3 has found that 26% to 29% of the radical prostatectomies performed at The Johns Hopkins Hospital contained potentially insignificant cancers. These trends highlight that we are detecting prostate cancer at an earlier stage. This shift in the stage of detected disease has resulted from more vigilant testing and screening for serum prostate-specific antigen and increased public awareness during the last 15 years.Additionally, some investigators have recently argued in favor of lowering the prostate-specific antigen cutoff from 4.0 to 2.5 ng/mL, particularly in younger men, which may have also contributed to the growing biopsy lists in our clinics.4 After 2000, extended prostate biopsies with 8, 10, or more biopsy cores (vs 6, which had been routine during the 1990s) have become the norm in many institutions, including ours. The extended biopsy sampling strategies (from 6–12 cores) have increased the overall detection rates and have likely resulted in detection of cancer at an earlier stage.5 Our study documented higher incidence of vanishing cancer after 10-core biopsy than previously reported for studies using 6-core biopsies. However, it is still controversial whether the increased biopsy strategies have independently increased the current rates of clinically insignificant and vanishing cancers.In summary, we believe that the trend of finding no cancer on prostatectomy has been driven not by the selection of the patient population for surgery but by the widespread prostate-specific antigen testing that has resulted in disease stage-shift during the last 2 decades.
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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 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.023 | 0.029 |
| Insufficient payload (model declined to judge) | 0.049 | 0.039 |
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".