RCT n= ~1500. >90% of patients walking through the door with target indication were randomized. Zero funding. Clinical integration and rethinking informed consent transformational. journals.lww.com/anesthesiolo...

Gosh, who could have predicted that the men who complained that they were being "censored!" during the pandemic phase of Covid (Prasad, Bhattacharya) are now leading the nation's health agencies & CENSORING others? "staffers are terrified of pushing back on Prasad, lest they face retaliation"

Recently been debating "cancer screening skeptics" about endpoints in screening RCTs. They insist on overall survival (OS); when I point out feasibility issues, they say infeasibility of RCT on OS proves screening doesn't work. Prejudice masquerading as methodologic rigor.

Appreciated this editorial on the long term results from the prostate cancer screening trial. It's hard to believe we are doing the best we can be when it comes to this screening tool. Screening effectiveness needs to be re-evaluated over time as practices change. www.nejm.org/doi/full/10....

After my son’s team lost in semi-finals of frisbee nationals 2024, he wrote to team “I love you all. This is how we do better next year …”. 2025: national champions. Something for science to learn from the sporting world: respect and motivate your team and good things will happen.

Folks (Prasad etc) who say “cancer screening must improve overall survival”, let's take a real example, ovarian cancer. ~0.7% mortality; salpingectomy reduces risk by ≥50%. Trial could be powered on cancer mortality (n~20,000) vs. overall (n~750,000). Which would you recommend?

Whether / how to do PSA screening complex topic highly dependent on detailed knowledge. Plenty of room for reasonable disagreement. But I’m getting pretty tired of self-proclaimed skeptics who, without specialist knowledge, smugly condescend anyone supporting PSA as naive.

Very common to ask patients to rate pain from "no pain" (0) to "worst pain imaginable / possible" (10). Here is a randomized trial showing anchor for pain score of 10 should be "extreme pain" (TL;DR: we want to evaluate pain, not imagination) pmc.ncbi.nlm.nih.gov/articles/PMC...

Guidelines group argues against lymph node dissection in radical prostatectomy by cherry-picking outlying studies eg systematic review finds 5 studies on lymphedema only 1 with p<5%; authors cite that one study and ignore systematic review. www.europeanurology.com/article/S030...

All wrapped up in a neat little bow. Covid conspiracy theorist encourages her lymphoma afflicted daughter to refuse chemotherapy. The daughter dies. The mother blames paramedics for the death. www.theguardian.com/society/2025...

Large multicenter study: "When grade group discordant between systematic & targeted biopsy, risk is intermediate. Current approach assigning highest grade should be abandoned ... consider de-escalating treatment when grade discordant." academic.oup.com/jnci/advance...

My theory of medical evidence is simple: observational studies for me, RCTs for you.

Remarkable study from the Malmo Preventive Project: ~1000 men with blood at 60 in 1981; no PSA screening, *lifetime* follow-up. >50% life years lost to prostate cancer in PSA>4.0; 85% for PSA >2.0. Focus screening for men in 60s in men with higher PSAs! academic.oup.com/jnci/advance...

Now seen two papers claiming PLND not needed in a subgroup with relatively low incidence of positive nodes at radical prostatectomy. Neither cite the RCT showing benefit of PLND. When RCT says “do X”, don’t eyeball a case-series to conclude “don’t do X”.

This is big! Worked with great statisticians on guidelines for meta-analysis & systematic review. We discuss rationales for systematic review, evaluation & interpretation of heterogeneity, & common errors in network meta-analysis, funnel plots etc. www.europeanurology.com/article/S030...

Urologists do well with probability estimates vs. clinical scenarios. Goes against 25 years of me hearing "clinicians are too dumb to understand numbers, just tell them what to do". doi.org/10.1097/UPJ....

Thrilled to share our new @BJUIjournal study! 📊 Quantifying Gleason pattern 4 via MRI & targeted biopsy predicts prostate cancer metastasis better than standard Gleason grading & risk scores. Precision matters in risk stratification. 🔗 doi.org/10.1111/bju.... @vickersbiostats.bsky.social

No.

Folks discuss replication crisis as if something new. But remember Hans Eysenck (an OG scientific racist)? Both "Eysenck was the most frequently cited living psychologist" & "14 papers retracted, 60 statements of concern issued by journals" en.wikipedia.org/wiki/Hans_Ey...

No justification for arbitrary age cut-offs in clinical trials (e.g. excluding patients over 75) www.theguardian.com/society/2025...

A comment on some invalid criticisms of the radical prostatectomy lymph node dissection trial www.sciencedirect.com/science/arti...

The Gleason score - the fundamental determinant of how we chose on treatments in localized prostate cancers - basically doesn't make any sense. grandroundsinurology.com/away-from-th...

I keep hearing "AI models have to be explainable otherwise doctors and patients won't trust them". But if I Google "does explainability improve trust in AI?", I get an AI summary (short answer "yes") created by an AI process that probably <1% of the population understands.

Results of observational study almost perfectly match those of our RCT. Hazard ratios of 1.07 / 0.72 for BCR / mets; RCT reported 1.05 / 0.82. Conclusions: do extended PLND during radical prostatectomy; effects of PLND occur after BCR. www.auajournals.org/doi/pdf/10.1...

You can have all the omni-omics data in the world and the bestest algorithms, but eventually a predicted probability is produced & it should be evaluated using well-established methods, and correctly implemented in the context of medical decision making. statsepi.substack.com/i/140315566/...

There is no scientific concept of "real world" data or evidence - there is nothing about this terminology that can't be more accurately and honestly conveyed using other accepted methodological terms.

With my kids after Robin (bottom left) wins Gold at U24 Ultimate Frisbee World Championships

When I first started covering Kate Shemirani during the acute phase of the pandemic I said her medical disinformation would kill people. Tragic that her own daughter is one of her victims - arrogant, narcissistic conspiracy theorists kill innocent people www.bbc.com/news/article...

"Patients with grade group (GG) 1 on biopsy can have higher grade disease on surgery. So GG1 = cancer". But also true of benign: "Patients with benign on biopsy can have higher grade disease on surgery"

Psychometricians develop questionnaires, then require permission to use / modify. Is there any other scientific methodology, whether lab (eg PCR), statistical (eg ttest), design (eg factorial), psychologic (eg cognitive debrief), where originators demand such permission?

This is a remarkable reversal on observational studies for the great Vinay Prasad!

Current "informed consent" policies on PSA-screening lead to higher incidence of metastatic prostate cancer in socioeconomically deprived neighborhoods pmc.ncbi.nlm.nih.gov/articles/PMC11

What is the best evidence that presence of cribriform improves our ability to risk stratify prostate cancer? Please send citations to papers showing e.g. improvement in discrimination of a standard nomogram.

Have presented “Replace Gleason score with quantification of pattern 4 (after suitable research)” to > 30 different prostate cancer groups. Despite radical premise – change fundamental basis of treatment – remarkably little push back: it just seems kind of obvious to most folks.

Study on London 20 mph limits shows: - collisions ⬇️ 35% - casualties ⬇️ 36% - fatal/serious injuries ⬇️ 34% - child casualties ⬇️ 46% - child deaths ⬇️ 75% - walkers, cyclists, motorcyclists killed/seriously injured ⬇️ 28% etsc.eu/20mph-limits...

Major systematic review on PSMA PET in prostate cancer concludes "PSMA PET cannot be used alone to determine the need for lymph node dissection (LND)." Time to end the practice of negative PSMA PET = no LND sciencedirect.com/science/arti...

Can we stop calling non-randomized trials "Phase III"? pubmed.ncbi.nlm.nih.gov/40118738/

A tactic of the anti lymph node dissection crowd is to exaggerate risks. Here, a 17% risk of lymphocele is claimed, with a citation to a systematic review. The review included several papers showing risks of 2-3% and one small abstract showing 17%. pdf.sciencedirectassets.com/272280/1-s2....

European Urology is recruiting associate statistical editors! A high impact journal with long track record of innovations in statistical peer review, this a fantastic opportunity for junior statisticians to gain (paid) experience at a top journal. Email me if interested www.europeanurology.com

Feel this pain. statsepi.substack.com/p/the-review...

I think I did pretty well at AUA. However, my son *crushed* in the first game of the season, beating the team he grew up following www.youtube.com/watch?v=0bhu...

Latest data from PBCG on MRI prostate biopsy: 2-fold variation in probability PI-RADS 4/5 across 13 sites after adjustment for case mix. Risk of GG ≥2 disease for PI-RADS 4/5 varied between 23%-68% / 49%-87%. Need better standardization www.sciencedirect.com/science/arti...

recommendations on which prediction model performance measures to report and which not too by @benvancalster.bsky.social more discussion here… arxiv.org/abs/2412.10288 #memtab

"Expanding eligibility for AS and the uptake of AS in men with favourable GG2 PCa is crucial to address the stage shift resulting from the increased accuracy of MRI." bjui-journals.onlinelibrary.wiley.com/doi/10.1111/...

Proceduralism in Science: use of simplistic rules of thumb to replace informed judgement for evaluating scientific studies. Examples include: correlation does not imply causation, prospective better than retrospective, ignore secondary endpoint in RCT if primary not significant

How to write a response to reviewers. www.sciencedirect.com/science/arti...

See my responses to this thread about how to do PSA screening right and wrong. bsky.app/profile/vick...

Compared to Goteborg 2 screening (PSA then MRI; NEJM) and PROSCREEN (PSA then marker then MRI; JAMA), BARCODE PRS based screening found fewer significant cancers (grade group 2+), more insignificant cancer and biopsied more men (the trifecta!). www.nejm.org/doi/full/10....