My point is the story is not yet over and declaring radiation the ‘New Gold Standard’ based on ProtecT 15-year results is a bit rich. Also need to take into account ProtecT non-compliance with allocation rates of 28% (RP), 24% (RT) and 16% (AM).

I caution early celebration – perhaps wait for the 20 year ProtecT publication. The 15-year report had a sneak peek at PCa specific death between 15 and 20 years. For radiation was 7 times higher than prostatectomy and 3.5 times higher than active monitoring.

I have 2 foundational issues with this paper and its ability to show a difference: Phoenix has a sensitivity of ~65% (see Roach et al table) meaning it has a high false negative rate. Failures are missed! Four years is early to be looking at Mets free. There is little interpretable here.

Is the theory that IDC and Cribriform are MRI visible? That would complete the loop here (and skip over Bx sampling error)

Excellent study! High specificity and sensitivity on final path - UH on biopsy is currently high specificity low sensitivity: relevant for GG2 on the threshold of AS candidacy. So important with the backdrop that PROTECT long term hadn’t stratify by current risk groups.

In as much as all cats are not dangerous (kittens vs. tigers) not all cancer is lethal (GG1 prostate cancer vs. Stage 4 lung cancer)

I disagree that ProtecT is a low-risk study. A third of the patients were intermediate risk at diagnosis, but it was before MRI. If you diagnosed the ProtecT population today with MRI guided biopsy half would be intermediate-risk.