Editorial Comment: Radical prostatectomy without prior biopsy following multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography
Bibliographic record
Abstract
Recently published in European Urology, Meissner et al (1) presented a series of 25 patients undergoing radical prostatectomy without performing a prostate biopsy, basing the surgical approach on the combination of multiparametric prostate resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA).Using the criterion of PIRADS≥4 and PET-Score≥4, 25 patients presented 100% of ISUP≥2.Despite the result found, we must be aware of the various weaknesses of the study and the potential repercussions that may be erroneously considered.The aforementioned study is a retrospective analysis, with a small number of patients, and some ethical issues to consider.The approach certainly shows the potential of imaging risk stratification but simultaneously falls into the controversial field of cancer treatment without pathology support and patient exposure to the morbidity of radical prostatectomy.Although it was described that the patient was extensively instructed on the need for a prostate biopsy to better understand the disease and, then, to define the available therapeutic options (active surveillance, focal therapy, surgery, or radiotherapy), the surgical
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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 | 0.008 | 0.036 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.031 | 0.025 |
| Insufficient payload (model declined to judge) | 0.011 | 0.010 |
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".