Andrew Vickers
@vickersbiostats.bsky.social
Biostatistician at Memorial Sloan Kettering Cancer Center. Special interest in prostate cancer, risk prediction, patient-reported outcomes, decision-making.
Yet again, PRS do not differentially distinguish aggressive from indolent cancer. & BARCODE RCT showed poor results compared to MRI etc. Yet the authors give a thumbs up to genomics in prostate cancer screening. When is the PRS fever going to break? www.nature.com/articles/s43...
Genomic risk model to implement precision prostate cancer screening in clinical care: the ProGRESS study - Nature Cancer
Vassy, Dornisch and colleagues developed a genomics-based prostate cancer risk model to support a randomized clinical trial of precision screening in a national healthcare system.
www.nature.com
January 27, 2026 at 1:12 PM
Yet again, PRS do not differentially distinguish aggressive from indolent cancer. & BARCODE RCT showed poor results compared to MRI etc. Yet the authors give a thumbs up to genomics in prostate cancer screening. When is the PRS fever going to break? www.nature.com/articles/s43...
Too many meta-analyses have findings equivalent to: “If you average the cost of a loaf of bread, car insurance for a year and a movie ticket, you get $752.36”
January 26, 2026 at 11:41 AM
Too many meta-analyses have findings equivalent to: “If you average the cost of a loaf of bread, car insurance for a year and a movie ticket, you get $752.36”
Reposted by Andrew Vickers
1) A covariate that is predictive of outcome should be in the model even if unpredictive of assignment (eg matched pairs design).
2) A covariate that is not predictive of outcome should not be in the model, even if predictive of assignment.
3) The propensity score is stupid.
2) A covariate that is not predictive of outcome should not be in the model, even if predictive of assignment.
3) The propensity score is stupid.
January 14, 2026 at 11:48 PM
1) A covariate that is predictive of outcome should be in the model even if unpredictive of assignment (eg matched pairs design).
2) A covariate that is not predictive of outcome should not be in the model, even if predictive of assignment.
3) The propensity score is stupid.
2) A covariate that is not predictive of outcome should not be in the model, even if predictive of assignment.
3) The propensity score is stupid.
When discussing PSA screening policy, we often contrast two options as opportunistic vs. population-based PSA screening. Would suggest a name change to disorganized vs. organized PSA screening.
January 14, 2026 at 11:17 AM
When discussing PSA screening policy, we often contrast two options as opportunistic vs. population-based PSA screening. Would suggest a name change to disorganized vs. organized PSA screening.
Number of papers on PubMed using the term "real world data" in 2000: 6. Number in 2025: ~5000. Number of papers for which "real world data" would be a meaningful scientific term: 0.
January 6, 2026 at 6:12 PM
Number of papers on PubMed using the term "real world data" in 2000: 6. Number in 2025: ~5000. Number of papers for which "real world data" would be a meaningful scientific term: 0.
@amit_sud
PRS-based prostate cancer screening has worse properties than contemporary approaches: "BARCODE1 biopsied more men, diagnosed more low-grade PCs & detected fewer high-grade PCs versus Göteborg-2 and ProScreen." authors.elsevier.com/sd/article/S...
PRS-based prostate cancer screening has worse properties than contemporary approaches: "BARCODE1 biopsied more men, diagnosed more low-grade PCs & detected fewer high-grade PCs versus Göteborg-2 and ProScreen." authors.elsevier.com/sd/article/S...
ScienceDirect.com | Science, health and medical journals, full text articles and books.
authors.elsevier.com
January 5, 2026 at 3:41 PM
@amit_sud
PRS-based prostate cancer screening has worse properties than contemporary approaches: "BARCODE1 biopsied more men, diagnosed more low-grade PCs & detected fewer high-grade PCs versus Göteborg-2 and ProScreen." authors.elsevier.com/sd/article/S...
PRS-based prostate cancer screening has worse properties than contemporary approaches: "BARCODE1 biopsied more men, diagnosed more low-grade PCs & detected fewer high-grade PCs versus Göteborg-2 and ProScreen." authors.elsevier.com/sd/article/S...
ProQuant collaboration: >100 urologists, radiation oncologists, pathologists, radiologists, biostatisticians, & ML experts from 34 institutions worldwide evaluating whether & how tumor quantification offers superior risk stratification to Gleason score. www.sciencedirect.com/science/arti...
Evaluating Tumor Quantification in Place of Proportions in Prostate Cancer: Principles of the ProQuant Group
www.sciencedirect.com
December 18, 2025 at 9:17 PM
ProQuant collaboration: >100 urologists, radiation oncologists, pathologists, radiologists, biostatisticians, & ML experts from 34 institutions worldwide evaluating whether & how tumor quantification offers superior risk stratification to Gleason score. www.sciencedirect.com/science/arti...
Lysenko is a bit of a bogeyman in science. But I have to say, rereading his story, hard not to draw parallels with Prasad, Makary, Bhattacharya and Hoeg. en.wikipedia.org/wiki/Trofim_...
Trofim Lysenko - Wikipedia
en.wikipedia.org
December 18, 2025 at 7:45 PM
Lysenko is a bit of a bogeyman in science. But I have to say, rereading his story, hard not to draw parallels with Prasad, Makary, Bhattacharya and Hoeg. en.wikipedia.org/wiki/Trofim_...
Reposted by Andrew Vickers
Our guidance regarding performance measures for medical AI models is finally out!
- Stop bashing AUROC, although it does not settle things
- Calibration and clinical utility are key
- Show risk distributions
- Classification statistics (e.g. F1) are improper
www.thelancet.com/journals/lan...
- Stop bashing AUROC, although it does not settle things
- Calibration and clinical utility are key
- Show risk distributions
- Classification statistics (e.g. F1) are improper
www.thelancet.com/journals/lan...
Evaluation of performance measures in predictive artificial intelligence models to support medical decisions: overview and guidance
Numerous measures have been proposed to illustrate the performance of predictive artificial
intelligence (AI) models. Selecting appropriate performance measures is essential
for predictive AI models i...
www.thelancet.com
December 13, 2025 at 2:04 PM
Our guidance regarding performance measures for medical AI models is finally out!
- Stop bashing AUROC, although it does not settle things
- Calibration and clinical utility are key
- Show risk distributions
- Classification statistics (e.g. F1) are improper
www.thelancet.com/journals/lan...
- Stop bashing AUROC, although it does not settle things
- Calibration and clinical utility are key
- Show risk distributions
- Classification statistics (e.g. F1) are improper
www.thelancet.com/journals/lan...
Working on a paper on informed decision making for PSA screening. Looking for any literature demonstrating that PSA screening is a preference sensitive decision and / or any data that these preferences can be accurately elicited in primary care. Please advise.
December 9, 2025 at 2:17 AM
Working on a paper on informed decision making for PSA screening. Looking for any literature demonstrating that PSA screening is a preference sensitive decision and / or any data that these preferences can be accurately elicited in primary care. Please advise.
Machine learning has developed remarkable new ideas about how to develop prediction algorithms. But always baffled me why the field had to reinvent how to evaluate models. Here we show F score should not be used to evaluate medical prediction models link.springer.com/epdf/10.1186...
The F score ranks diagnostic tests and prediction models inconsistently with their clinical utility
link.springer.com
December 8, 2025 at 6:53 PM
Machine learning has developed remarkable new ideas about how to develop prediction algorithms. But always baffled me why the field had to reinvent how to evaluate models. Here we show F score should not be used to evaluate medical prediction models link.springer.com/epdf/10.1186...
Five things you need to know about prostate cancer diagnostic tests www.sciencedirect.com/science/arti...
Five things you need to know about prostate cancer diagnostic tests
www.sciencedirect.com
December 5, 2025 at 5:48 PM
Five things you need to know about prostate cancer diagnostic tests www.sciencedirect.com/science/arti...
For those who complained about the recent RCT on PSA not looking at overall mortality, note that Gil Welch, the well-respected screening skeptic, concluded "It is not feasible to test all-cause mortality when screening for an individual cancer"
pubmed.ncbi.nlm.nih.gov/37639251/
pubmed.ncbi.nlm.nih.gov/37639251/
Testing Whether Cancer Screening Saves Lives: Implications for Randomized Clinical Trials of Multicancer Screening - PubMed
It is not feasible to test all-cause mortality when screening for an individual cancer. However, it is feasible to test all-cause mortality for multicancer screening because cancer deaths are such a large component of deaths in general. Observational data on the effects of cancer screening are misle …
pubmed.ncbi.nlm.nih.gov
December 4, 2025 at 4:19 PM
For those who complained about the recent RCT on PSA not looking at overall mortality, note that Gil Welch, the well-respected screening skeptic, concluded "It is not feasible to test all-cause mortality when screening for an individual cancer"
pubmed.ncbi.nlm.nih.gov/37639251/
pubmed.ncbi.nlm.nih.gov/37639251/
MRI is a great tool in prostate cancer. The problem is, quality in practice might not be quality we see in studies. Nice study from @dr_coops showing that in the VA, MRI not good enough to rule out biopsy. jamanetwork.com/journals/jam...
Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance
This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.
jamanetwork.com
November 24, 2025 at 2:23 PM
MRI is a great tool in prostate cancer. The problem is, quality in practice might not be quality we see in studies. Nice study from @dr_coops showing that in the VA, MRI not good enough to rule out biopsy. jamanetwork.com/journals/jam...
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...
journals.lww.com
November 10, 2025 at 9:23 PM
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...
Reposted by Andrew Vickers
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"
"staffers are terrified of pushing back on Prasad, lest they face retaliation"
EXCLUSIVE: A slow-boiling feud between Vinay Prasad and his staff at the FDA is threatening the future of the center that regulates the nation’s vaccines, biological products, and blood supply. Read more here:
www.statnews.com/2025/10/31/v...
www.statnews.com/2025/10/31/v...
Under Vinay Prasad, employees at a key FDA center fear speaking out, look for the exits
Exclusive: Vinay Prasad has rattled FDA staff by expanding his power and pushing out senior leaders.
www.statnews.com
October 31, 2025 at 4:28 PM
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"
"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.
October 30, 2025 at 3:26 PM
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.
Reposted by Andrew Vickers
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....
www.nejm.org/doi/full/10....
Early Detection of Prostate Cancer — Time to Fish or Cut Bait | NEJM
Approaches to early detection of cancer often seem contentious, but the big-picture view is actually one of remarkable consensus. All major guideline groups recommend the Papanicolaou smear, mammog...
www.nejm.org
October 30, 2025 at 1:23 PM
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....
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.
October 29, 2025 at 2:09 PM
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?
October 28, 2025 at 3:03 AM
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.
October 16, 2025 at 2:29 PM
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...
Client Challenge
jpro.springeropen.com
October 13, 2025 at 3:08 PM
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...
Re: Matthew J. Roberts, Giorgio Gandaglia, Daniela E. Oprea-Lager, et al. Pelvic Lymph Node Dissection in Prostate Cancer: Evidence and Implications. Eur Urol 2025;87:619–21
There is an ongoing debate about whether the benefits of lymph node dissection (LND)
during radical prostatectomy outweigh the harms. We previously published a commentary
describing how opponents of L...
www.europeanurology.com
October 7, 2025 at 10:33 AM
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...
UK woman who refused cancer drugs was influenced by mother, inquest finds
Paloma Shemirani, 23, died after refusing chemotherapy for non-Hodgkin lymphoma despite doctors’ concerns
www.theguardian.com
October 2, 2025 at 3:31 PM
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...
Assessing the oncologic risk when systematic and multiparametric magnetic resonance imaging-targeted prostate biopsy grade groups are discordant
AbstractBackground and Objective. In the systematic biopsy (SBx) era, prostate biopsy grading followed the rule that the ISUP grade group (GG) assigned was
academic.oup.com
September 29, 2025 at 3:57 PM
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...