Andrew Vickers
@VickersBiostats
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Biostatistician at Memorial Sloan Kettering Cancer Center. Special interest in prostate cancer, risk prediction, patient-reported outcomes, decision-making.
New York
Joined February 2020
@VickersBiostats I honestly feel like this whole all cause mortality issue was just ginned up to feed Twitter through EBM chest puffing & virtue signaling. I generally ignore it because there are actual complex q's out there.
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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" https://t.co/keyZ0INBrT
pubmed.ncbi.nlm.nih.gov
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...
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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
This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.
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This is what X has done to scientific debate. I suggest "publish a paper, and I'd advise statistical advice". Publishing a scientific paper = "gatekeeping". Getting statistical advice = "credentialism".
@VickersBiostats Lol What a shocker, more gatekeeping & credentialism Or you could just answer More people you would want to reach will read this than a L2E Which also I've never seen for a paper 2+ years later And doubtful would get a fair shake given who is on the editorial board :)
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Families of 4 in 2025 paid the following for their healthcare as members of CrowdHealth: Jan - $475 Feb - $460 March - $445 April - $460 May - $505 June - $505 July - $445 Aug - $475 Sept - $475 Oct - $475 Nov - $505 Dec - $490 Total - $5,715 Members pay the first $500 of any
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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
thesized that combining PECS I (interpectoral) nerve blocks with either paravertebral or serratus anterior plane blocks would reduce opioid use after mastectomy with expander reconstruction compared...
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Didn't I comment on this before? Screening cynics stating that anyone who favors screening is a little naive and doesn't get the science.
@Adam_Weiner535 @VickersBiostats If you think the answer is it "works" unequivocally, then you arent doing SDM Tradeoffs are huge Is there room to innovate? Yes! But testable hypothesis Everyone for decades thought psa screening was amazing and no brainer Science & medicine is hard
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Yet again, we have a non-statistician accusing highly respected statisticians of "shenanigans" based on their own lack of understanding of statistics.
This paper may win the 2025 Y-Axis shenanigans award 👇🏻
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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.
At 23 years of follow-up, population-based PSA screening of asymptomatic men led to a sustained reduction in prostate cancer mortality, although overdiagnosis remains a concern. Full ERSPC study results: https://t.co/DTw9NcUFJM Editorial: Early Detection of Prostate Cancer —
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Incredibly important data! Tradeoffs of PSA screening markedly improve with additional follow up @MoniqueRoobol @NEJM Nice editoral by @VickersBiostats
https://t.co/oFYJJe4NCO
https://t.co/ojWVGTYofK
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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 sporting world: respect and motivate your team and good things will happen.
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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?
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This is, of course, completely false. The PRS NEJM study had far worse properties that Goteborg 2, Stockholm 3 or ProScreen that used PSA, MRI plus minus markers.
đź’ˇ Words of Wisdom Wednesday A new Word of Wisdom in European Urology discusses the landmark NEJM study by McHugh et al. on polygenic risk scores (PRS) for prostate cancer screening. PRS-based approaches significantly improved the detection of clinically significant prostate
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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.
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What a great study - nice work @SigridCarlsson! I've always hated the 0-10 pain question, telling people that if 10 was truly the worst pain possible (and the scale was linear), then almost no one in a healthcare setting would ever be above a 1! Glad this finally got addressed
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)
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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)
link.springer.com
Journal of Patient-Reported Outcomes - A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no...
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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.
europeanurology.com
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...
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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.
theguardian.com
Paloma Shemirani, 23, died after refusing chemotherapy for non-Hodgkin lymphoma despite doctors’ concerns
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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
AbstractBackground. In the systematic biopsy era, prostate biopsy grading followed the rule that the International Society of Urological Pathology grade gr
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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
AbstractBackground. We investigated the natural history of the relationship between prostate-specific antigen (PSA) at age 60 years and lifetime risk of pr
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