Storm over screening for prostate specific antigen
Bibliographic record
Abstract
Editor—Yamey and Wilkes argue that questioning cancer screening, specifically prostate specific antigen (PSA) screening can be a risky business in America.1 My prostate cancer, like so many others, was silent and only revealed after a PSA test that my daughter nagged me into adding to my biennial company medical examination—unfortunately too late to guarantee a cure. After surgery and adjuvant radiotherapy I probably have a better prognosis than two colleagues who presented with bone metastases (and PSA values, when tested, in the 100s). My PSA result alerted me to a potential problem and let me enter an informed debate with the medical profession—no one forced me to have a biopsy, or an operation, or opt for surgery over radiotherapy, or decline hormone therapy, or do nothing. I could talk to my doctors, read books, and use the internet. I could assess the risks and benefits of a radical prostatectomy and, what is more, carry out this assessment against the background of a medical profession uncertain as to the best course of treatment for someone presenting with my results. The key issue is that I could participate in making a life threatening personal decision, rather than have participation (and, by extension, timely treatment) denied to me because PSA screening had been ruled out for the entire male population on the basis of historical statistics. I am enough of a cynic to believe that some of the uncertainty surrounding PSA testing policy in the United Kingdom relates to resources. During my decision making process, I came across a paper on dilemmas in treating early prostate cancer.2 It was easy to work out that there just aren't enough experienced urologists (who are dextrous enough to carry out this tricky operation successfully and have the courage to attempt it) to carry out the number of radical prostatectomies that early detection by PSA testing would indicate. This sample of 244 urologists had a mean of 14.1 years' experience (range 2-30 years), and 130 of them managed 100 patients or more with prostate cancer. Expertise in performing radical prostatectomy was restricted to comparatively few—98 reported having ever performed the procedure and only 12 (14%) that they performed 20 or more operations yearly. I also suspect that the United Kingdom is far short of the number of three dimensional conformal radiotherapy machines needed to offer that treatment option.
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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 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.042 | 0.037 |
| Insufficient payload (model declined to judge) | 0.011 | 0.007 |
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".