Concept Bottleneck Models (CBMs) are interpretable models that predict the target variable through high-level human-understandable concepts, allowing users to intervene on mispredicted concepts to adjust the final output. While recent work has shown that modeling dependencies between concepts can improve CBM performance, especially under interventions, such approaches typically require retraining the entire model, which may be infeasible when access to the original data or compute is limited. In this paper, we introduce Post-hoc Stochastic Concept Bottleneck Models (PSCBMs), a lightweight method that augments any pre-trained CBM with a multivariate normal distribution over concepts by adding only a small covariance-prediction module, without retraining the backbone model. We propose two training strategies and show on real-world data that PSCBMs consistently match or improve both concept and target accuracy over standard CBMs at test time. Furthermore, we show that due to the modeling of concept dependencies, PSCBMs perform much better than CBMs under interventions, while remaining far more efficient than retraining a similar stochastic model from scratch.

Wiktor Jan Hoffmann, Sonia Laguna, Moritz Vandenhirtz, Emanuele Palumbo, Julia E Vogt

International Conference on Learning Representations (ICLR) Workshop on Trustworthy AI

27.04.2026

Link

Machine unlearning is rapidly becoming a practical requirement, driven by privacy regulations, data errors, and the need to remove harmful or corrupted training samples. Despite this, most existing methods tackle the problem purely from a post-hoc perspective. They attempt to erase the influence of targeted training samples through parameter updates that typically require access to the full training data. This creates a mismatch with real deployment scenarios where unlearning requests can be anticipated, revealing a fundamental limitation of post-hoc approaches. We propose unlearning by design, a novel paradigm in which models are directly trained to support forgetting as an inherent capability. We instantiate this idea with Machine UNlearning via KEY deletion (MUNKEY), a memory augmented transformer that decouples instance-specific memorization from model weights. Here, unlearning corresponds to removing the instance-identifying key, enabling direct zero-shot forgetting without weight updates or access to the original samples or labels. Across natural image benchmarks, fine-grained recognition, and medical datasets, MUNKEY outperforms all post-hoc baselines. Our results establish that unlearning by design enables fast, deployment-oriented unlearning while preserving predictive performance.

Sonia Laguna, Jorge da Silva Gonçalves, Moritz Vandenhirtz, Alain Ryser, Irene Cannistraci^†, Julia E Vogt^†
† denotes shared last authorship

Oral at ICLR Workshop TTU

26.04.2026

Link

Building robust medical machine learning systems requires pretraining strategies that exploit the intrinsic structure present in clinical data. We introduce Multiview Masked Autoencoder (MVMAE), a self-supervised framework that leverages the natural multi-view organization of radiology studies to learn view-invariant and disease-relevant representations. MVMAE combines masked image reconstruction with cross-view alignment, transforming clinical redundancy across projections into a powerful self-supervisory signal. We further extend this approach with MVMAE-V2T, which incorporates radiology reports as an auxiliary text-based learning signal to enhance semantic grounding while preserving fully vision-based inference. Evaluated on a downstream disease classification task on three large-scale public datasets, MIMIC-CXR, CheXpert, and PadChest, MVMAE consistently outperforms supervised and vision-language baselines. Furthermore, MVMAE-V2T provides additional gains, particularly in low-label regimes where structured textual supervision is most beneficial. Together, these results establish the importance of structural and textual supervision as complementary paths toward scalable, clinically grounded medical foundation models.

Sonia Laguna^*, Andrea Agostini^*, Alain Ryser, Samuel Ruiperez-Campillo, Irene Cannistraci, Moritz Vandenhirtz, Stephan Mandt, Nicolas Deperrois, Farhad Nooralahzadeh, Michael Krauthammer, Thomas M Sutter^†, Julia E Vogt^†
* denotes shared first authorship, ^† denotes shared last authorship

Transactions on Machine Learning Research (TMLR)

22.03.2026

Link

We present RadVLM, a compact (7B) multitask conversational foundation model designed for CXR interpretation. Its development relies on the curation of a large-scale instruction dataset comprising over 1 million image-instruction pairs containing both single-turn tasks - such as report generation, abnormality classification, and visual grounding - and multi-turn, multi-task conversational interactions. Our experiments show that RadVLM, fine-tuned on this instruction dataset, achieves state-of-the-art performance in conversational capabilities and visual grounding while remaining competitive in other radiology tasks (report generation, classification). Ablation studies further highlight the benefit of joint training across multiple tasks, particularly for scenarios with limited annotated data. Together, these findings highlight the potential of the RadVLM model as a clinically relevant AI assistant, providing structured CXR interpretation and conversational capabilities to support more effective and accessible diagnostic workflows.

Nicolas Deperrois, Hidetoshi Matsuo, Samuel Ruipérez-Campillo, Moritz Vandenhirtz, Sonia Laguna, Alain Ryser, Koji Fujimoto, Mizuho Nishio, Thomas Sutter, Julia Vogt, Jonas Kluckert, Thomas Frauenfelder, Christian Bluethgen, Farhad Nooralahzadeh, Michael Krauthammer

Physionet

08.10.2025

LinkDOI

Generative modeling and clustering are conventionally distinct tasks in machine learning. Variational Autoencoders (VAEs) have been widely explored for their ability to integrate both, providing a framework for generative clustering. However, while VAEs can learn meaningful cluster representations in latent space, they often struggle to generate high-quality samples. This paper addresses this problem by introducing TreeDiffusion, a deep generative model that conditions diffusion models on learned latent hierarchical cluster representations from a VAE to obtain high-quality, cluster-specific generations. Our approach consists of two steps: first, a VAE-based clustering model learns a hierarchical latent representation of the data. Second, a cluster-aware diffusion model generates realistic images conditioned on the learned hierarchical structure. We systematically compare the generative capabilities of our approach with those of alternative conditioning strategies. Empirically, we demonstrate that conditioning diffusion models on hierarchical cluster representations improves the generative performance on real-world datasets compared to other approaches. Moreover, a key strength of our method lies in its ability to generate images that are both representative and specific to each cluster, enabling more detailed visualization of the learned latent structure. Our approach addresses the generative limitations of VAE-based clustering approaches by leveraging their learned structure, thereby advancing the field of generative clustering.

Jorge Silva Gonçalves, Laura Manduchi, Moritz Vandenhirtz, Julia E Vogt

Joint European Conference on Machine Learning and Knowledge Discovery in Databases

04.10.2025

LinkDOICode

We release the RadVLM instruction dataset, a large-scale resource used to train the RadVLM model on diverse radiology tasks. The dataset contains 1,115,021 image–instruction pairs spanning five task families: (i) report generation from frontal CXRs using filtered Findings/Impression text; (ii) abnormality classification for the standard 14 CheXpert labels; (iii) anatomy grounding; (iv) abnormality detection and grounding; and (v) phrase grounding from report sentences. To support interactive use, we include ~89k LLM-generated multi-turn, multi-task conversations (~3k with spatial grounding) derived from image-linked attributes (reports, labels, boxes). Creation involved curating datasets from public sources, excluding lateral views, removing prior-study references and other non-image context from reports, fusing multi-reader annotations, and harmonizing label and coordinate formats. The resource is intended for training CXR assistants across diverse radiology tasks and within a conversational format.

Nicolas Deperrois, Hidetoshi Matsuo, Samuel Ruipérez-Campillo, Moritz Vandenhirtz, Sonia Laguna, Alain Ryser, Koji Fujimoto, Mizuho Nishio, Thomas Sutter, Julia Vogt, Jonas Kluckert, Thomas Frauenfelder, Christian Bluethgen, Farhad Nooralahzadeh, Michael Krauthammer

Physionet

25.09.2025

LinkDOI

Building generalizable medical AI systems requires pretraining strategies that are data-efficient and domain-aware. Unlike internet-scale corpora, clinical datasets such as MIMIC-CXR offer limited image counts and scarce annotations, but exhibit rich internal structure through multi-view imaging. We propose a self-supervised framework that leverages the inherent structure of medical datasets. Specifically, we treat paired chest X-rays (i.e., frontal and lateral views) as natural positive pairs, learning to reconstruct each view from sparse patches while aligning their latent embeddings. Our method requires no textual supervision and produces informative representations. Evaluated on MIMIC-CXR, we show strong performance compared to supervised objectives and baselines being trained without leveraging structure. This work provides a lightweight, modality-agnostic blueprint for domain-specific pretraining where data is structured but scarce.

Andrea Agostini^*, Sonia Laguna^*, Alain Ryser^*, Samuel Ruipérez-Campillo^*, Moritz Vandenhirtz, Nicolas Deperrois, Farhad Nooralahzadeh, Michael Krauthammer, Thomas M Sutter^†, Julia E Vogt^†
* denotes shared first authorship, ^† denotes shared last authorship

International Conference of Machine Learning (ICML) 2025 Workshop on FM4LS

15.07.2025

Link

Understanding the decision-making process of machine learning models provides valuable insights into the task, the data, and the reasons behind a model’s failures. In this work, we propose a method that performs inherently interpretable predictions through the instance-wise sparsification of input images. To align the sparsification with human perception, we learn the masking in the space of semantically meaningful pixel regions rather than on pixel-level. Additionally, we introduce an explicit way to dynamically determine the required level of sparsity for each instance. We show empirically on semi-synthetic and natural image datasets that our inherently interpretable classifier produces more meaningful, human-understandable predictions than state-ofthe-art benchmarks.

Moritz Vandenhirtz, Julia E. Vogt

09.07.2025

Link

Concept Bottleneck Models (CBMs) aim to enhance interpretability by structuring predictions around human-understandable concepts. However, unintended information leakage, where predictive signals bypass the concept bottleneck, compromises their transparency. This paper introduces an information-theoretic measure to quantify leakage in CBMs, capturing the extent to which concept embeddings encode additional, unintended information beyond the specified concepts. We validate the measure through controlled synthetic experiments, demonstrating its effectiveness in detecting leakage trends across various configurations. Our findings highlight that feature and concept dimensionality significantly influence leakage, and that classifier choice impacts measurement stability, with XGBoost emerging as the most reliable estimator. Additionally, preliminary investigations indicate that the measure exhibits the anticipated behavior when applied to soft joint CBMs, suggesting its reliability in leakage quantification beyond fully synthetic settings. While this study rigorously evaluates the measure in controlled synthetic experiments, future work can extend its application to real-world datasets.

Mikael Makonnen, Moritz Vandenhirtz, Sonia Laguna, Julia E Vogt

International Conference on Learning Representations (ICLR) 2025 Workshop: XAI4Science

15.04.2025

Link

The widespread use of chest X-rays (CXRs), coupled with a shortage of radiologists, has driven growing interest in automated CXR analysis and AI-assisted reporting. While existing vision-language models (VLMs) show promise in specific tasks such as report generation or abnormality detection, they often lack support for interactive diagnostic capabilities. In this work we present RadVLM, a compact, multitask conversational foundation model designed for CXR interpretation. To this end, we curate a large-scale instruction dataset comprising over 1 million image-instruction pairs containing both single-turn tasks -- such as report generation, abnormality classification, and visual grounding -- and multi-turn, multi-task conversational interactions. After fine-tuning RadVLM on this instruction dataset, we evaluate it across different tasks along with re-implemented baseline VLMs. Our results show that RadVLM achieves state-of-the-art performance in conversational capabilities and visual grounding while remaining competitive in other radiology tasks. Ablation studies further highlight the benefit of joint training across multiple tasks, particularly for scenarios with limited annotated data. Together, these findings highlight the potential of RadVLM as a clinically relevant AI assistant, providing structured CXR interpretation and conversational capabilities to support more effective and accessible diagnostic workflows.

N Deperrois, H Matsuo, S Ruipérez-Campillo, M Vandenhirtz, S Laguna, A Ryser, K Fujimoto, M Nishio, TM Sutter, JE Vogt, J Kluckert, T Frauenfelder, C Blüthgen, F Nooralahzadeh, M Krauthammer

arXiv

01.02.2025

LinkDOI

Concept Bottleneck Models (CBMs) have emerged as a promising interpretable method whose final prediction is based on intermediate, human-understandable concepts rather than the raw input. Through time-consuming manual interventions, a user can correct wrongly predicted concept values to enhance the model's downstream performance. We propose Stochastic Concept Bottleneck Models (SCBMs), a novel approach that models concept dependencies. In SCBMs, a single-concept intervention affects all correlated concepts, thereby improving intervention effectiveness. Unlike previous approaches that model the concept relations via an autoregressive structure, we introduce an explicit, distributional parameterization that allows SCBMs to retain the CBMs' efficient training and inference procedure. Additionally, we leverage the parameterization to derive an effective intervention strategy based on the confidence region. We show empirically on synthetic tabular and natural image datasets that our approach improves intervention effectiveness significantly. Notably, we showcase the versatility and usability of SCBMs by examining a setting with CLIP-inferred concepts, alleviating the need for manual concept annotations.

Moritz Vandenhirtz^*, Sonia Laguna^*, Ričards Marcinkevičs, Julia E Vogt
^* denotes shared first authorship

NeurIPS: Thirty-Eighth Annual Conference on Neural Information Processing Systems

14.12.2024

LinkCode

Concept-based machine learning methods have increasingly gained importance due to the growing interest in making neural networks interpretable. However, concept annotations are generally challenging to obtain, making it crucial to leverage all their prior knowledge. By creating concept-enriched models that incorporate concept information into existing architectures, we exploit their interpretable capabilities to the fullest extent. In particular, we propose Concept-Guided Conditional Diffusion, which can generate visual representations of concepts, and Concept-Guided Prototype Networks, which can create a concept prototype dataset and leverage it to perform interpretable concept prediction. These results open up new lines of research by exploiting pre-existing information in the quest for rendering machine learning more human-understandable.

Alba Carballo-Castro, Sonia Laguna, Moritz Vandenhirtz, Julia E Vogt

NeurIPS 2024 Workshop Interpretable AI

12.12.2024

LinkCode

Recently, interpretable machine learning has re-explored concept bottleneck models (CBM), comprising step-by-step prediction of the high-level concepts from the raw features and the target variable from the predicted concepts. A compelling advantage of this model class is the user's ability to intervene on the predicted concept values, affecting the model's downstream output. In this work, we introduce a method to perform such concept-based interventions on already-trained neural networks, which are not interpretable by design, given an annotated validation set. Furthermore, we formalise the model's intervenability as a measure of the effectiveness of concept-based interventions and leverage this definition to fine-tune black-box models. Empirically, we explore the intervenability of black-box classifiers on synthetic tabular and natural image benchmarks. We demonstrate that fine-tuning improves intervention effectiveness and often yields better-calibrated predictions. To showcase the practical utility of the proposed techniques, we apply them to deep chest X-ray classifiers and show that fine-tuned black boxes can be as intervenable and more performant than CBMs.

Sonia Laguna^*, Ricards Marcinkevics^*, Moritz Vandenhirtz, Julia E. Vogt
^* denotes shared first authorship

NeurIPS: Thirty-Eighth Annual Conference on Neural Information Processing Systems

11.12.2024

LinkCode

Finding clusters of data points with similar characteristics and generating new cluster-specific samples can significantly enhance our understanding of complex data distributions. While clustering has been widely explored using Variational Autoencoders, these models often lack generation quality in real-world datasets. This paper addresses this gap by introducing TreeDiffusion, a deep generative model that conditions Diffusion Models on hierarchical clusters to obtain high-quality, cluster-specific generations. The proposed pipeline consists of two steps: a VAE-based clustering model that learns the hierarchical structure of the data, and a conditional diffusion model that generates realistic images for each cluster. We propose this two-stage process to ensure that the generated samples remain representative of their respective clusters and enhance image fidelity to the level of diffusion models. A key strength of our method is its ability to create images for each cluster, providing better visualization of the learned representations by the clustering model, as demonstrated through qualitative results. This method effectively addresses the generative limitations of VAE-based approaches while preserving their clustering performance. Empirically, we demonstrate that conditioning diffusion models on hierarchical clusters significantly enhances generative performance, thereby advancing the state of generative clustering models.

Jorge da Silva Goncalves, Laura Manduchi, Moritz Vandenhirtz, Julia E. Vogt

arXiv

22.10.2024

LinkDOI

The structure of many real-world datasets is intrinsically hierarchical, making the modeling of such hierarchies a critical objective in both unsupervised and supervised machine learning. Recently, novel approaches for hierarchical clustering with deep architectures have been proposed. In this work, we take a critical perspective on this line of research and demonstrate that many approaches exhibit major limitations when applied to realistic datasets, partly due to their high computational complexity. In particular, we show that a lightweight procedure implemented on top of pre-trained non-hierarchical clustering models outperforms models designed specifically for hierarchical clustering. Our proposed approach is computationally efficient and applicable to any pre-trained clustering model that outputs logits, without requiring any fine-tuning. To highlight the generality of our findings, we illustrate how our method can also be applied in a supervised setup, recovering meaningful hierarchies from a pre-trained ImageNet classifier.

Emanuele Palumbo, Moritz Vandenhirtz, Alain Ryser, Imant Daunhawer^†, Julia E. Vogt^†
† denotes shared last authorship

Preprint

10.10.2024

DOI

This paper introduces Diffuse-TreeVAE, a deep generative model that integrates hierarchical clustering into the framework of Denoising Diffusion Probabilistic Models (DDPMs). The proposed approach generates new images by sampling from a root embedding of a learned latent tree VAE-based structure, it then propagates through hierarchical paths, and utilizes a second-stage DDPM to refine and generate distinct, high-quality images for each data cluster. The result is a model that not only improves image clarity but also ensures that the generated samples are representative of their respective clusters, addressing the limitations of previous VAE-based methods and advancing the state of clustering-based generative modeling.

Jorge da Silva Gonçalves, Laura Manduchi, Moritz Vandenhirtz, Julia E. Vogt

ICML 2024 Workshop on Structured Probabilistic Inference & Generative Modeling

27.07.2024

Link

Concept Bottleneck Models (CBMs) have emerged as a promising interpretable method whose final prediction is based on intermediate, human-understandable concepts rather than the raw input. Through time-consuming manual interventions, a user can correct wrongly predicted concept values to enhance the model's downstream performance. We propose Stochastic Concept Bottleneck Models (SCBMs), a novel approach that models concept dependencies. In SCBMs, a single-concept intervention affects all correlated concepts. Leveraging the parameterization, we derive an effective intervention strategy based on the confidence region. We show empirically on synthetic tabular and natural image datasets that our approach improves intervention effectiveness significantly. Notably, we showcase the versatility and usability of SCBMs by examining a setting with CLIP-inferred concepts, alleviating the need for manual concept annotations.

Moritz Vandenhirtz^*, Sonia Laguna^*, Ricards Marcinkevics, Julia E. Vogt
^* denotes shared first authorship

ICML 2024 Workshop on Structured Probabilistic Inference & Generative Modeling, Workshop on Models of Human Feedback for AI Alignment, and Workshop on Humans, Algorithmic Decision-Making and Society

26.07.2024

Link

We propose Tree Variational Autoencoder (TreeVAE), a new generative hierarchical clustering model that learns a flexible tree-based posterior distribution over latent variables. TreeVAE hierarchically divides samples according to their intrinsic characteristics, shedding light on hidden structures in the data. It adapts its architecture to discover the optimal tree for encoding dependencies between latent variables. The proposed tree-based generative architecture enables lightweight conditional inference and improves generative performance by utilizing specialized leaf decoders. We show that TreeVAE uncovers underlying clusters in the data and finds meaningful hierarchical relations between the different groups on a variety of datasets, including real-world imaging data. We present empirically that TreeVAE provides a more competitive log-likelihood lower bound than the sequential counterparts. Finally, due to its generative nature, TreeVAE is able to generate new samples from the discovered clusters via conditional sampling.

Laura Manduchi^*, Moritz Vandenhirtz^*, Alain Ryser, Julia E. Vogt
^* denotes shared first authorship

Spotlight at Neural Information Processing Systems, NeurIPS 2023

20.12.2023

LinkCode

Recently, interpretable machine learning has re-explored concept bottleneck models (CBM), comprising step-by-step prediction of the high-level concepts from the raw features and the target variable from the predicted concepts. A compelling advantage of this model class is the user's ability to intervene on the predicted concept values, consequently affecting the model's downstream output. In this work, we introduce a method to perform such concept-based interventions on already-trained neural networks, which are not interpretable by design. Furthermore, we formalise the model's intervenability as a measure of the effectiveness of concept-based interventions and leverage this definition to fine-tune black-box models. Empirically, we explore the intervenability of black-box classifiers on synthetic tabular and natural image benchmarks. We demonstrate that fine-tuning improves intervention effectiveness and often yields better-calibrated predictions. To showcase the practical utility of the proposed techniques, we apply them to chest X-ray classifiers and show that fine-tuned black boxes can be as intervenable and more performant than CBMs.

Ricards Marcinkevics^*, Sonia Laguna^*, Moritz Vandenhirtz, Julia E. Vogt
^* denotes shared first authorship

XAI in Action: Past, Present, and Future Applications, NeurIPS 2023

16.12.2023

Link

Prototype learning, a popular machine learning method designed for inherently interpretable decisions, leverages similarities to learned prototypes for classifying new data. While it is mainly applied in computer vision, in this work, we build upon prior research and further explore the extension of prototypical networks to natural language processing. We introduce a learned weighted similarity measure that enhances the similarity computation by focusing on informative dimensions of pre-trained sentence embeddings. Additionally, we propose a post-hoc explainability mechanism that extracts prediction-relevant words from both the prototype and input sentences. Finally, we empirically demonstrate that our proposed method not only improves predictive performance on the AG News and RT Polarity datasets over a previous prototype-based approach, but also improves the faithfulness of explanations compared to rationale-based recurrent convolutions.

Claudio Fanconi^*, Moritz Vandenhirtz^*, Severin Husmann, Julia E. Vogt
^* denotes shared first authorship

Conference on Empirical Methods in Natural Language Processing, EMNLP 2023

25.10.2023

LinkDOICode

We propose a new generative hierarchical clustering model that learns a flexible tree-based posterior distribution over latent variables. The proposed Tree Variational Autoencoder (TreeVAE) hierarchically divides samples according to their intrinsic characteristics, shedding light on hidden structures in the data. It adapts its architecture to discover the optimal tree for encoding dependencies between latent variables, improving generative performance. We show that TreeVAE uncovers underlying clusters in the data and finds meaningful hierarchical relations between the different groups on several datasets. Due to its generative nature, TreeVAE can generate new samples from the discovered clusters via conditional sampling.

Laura Manduchi^*, Moritz Vandenhirtz^*, Alain Ryser, Julia E. Vogt
^* denotes shared first authorship

ICML 2023 Workshop on Structured Probabilistic Inference & Generative Modeling

30.06.2023

LinkCode

We propose a new generative hierarchical clustering model that learns a flexible tree-based posterior distribution over latent variables. The proposed Tree Variational Autoencoder (TreeVAE) hierarchically divides samples according to their intrinsic characteristics, shedding light on hidden structures in the data. It adapts its architecture to discover the optimal tree for encoding dependencies between latent variables, improving generative performance. We show that TreeVAE uncovers underlying clusters in the data and finds meaningful hierarchical relations between the different groups on several datasets. Due to its generative nature, TreeVAE can generate new samples from the discovered clusters via conditional sampling.

Laura Manduchi^*, Moritz Vandenhirtz^*, Alain Ryser, Julia E. Vogt
^* denotes shared first authorship

ICML 2023 Workshop on Deployment Challenges for Generative AI

30.06.2023

LinkCode

Spurious correlations are everywhere. While humans often do not perceive them, neural networks are notorious for learning unwanted associations, also known as biases, instead of the underlying decision rule. As a result, practitioners are often unaware of the biased decision-making of their classifiers. Such a biased model based on spurious correlations might not generalize to unobserved data, leading to unintended, adverse consequences. We propose Signal is Harder (SiH), a variational-autoencoder-based method that simultaneously trains a biased and unbiased classifier using a novel, disentangling reweighting scheme inspired by the focal loss. Using the unbiased classifier, SiH matches or improves upon the performance of state-of-the-art debiasing methods. To improve the interpretability of our technique, we propose a perturbation scheme in the latent space for visualizing the bias that helps practitioners become aware of the sources of spurious correlations.

Moritz Vandenhirtz, Laura Manduchi, Ricards Marcinkevics, Julia E. Vogt

Domain Generalization Workshop, ICLR 2023

04.05.2023

LinkCode

Objective: To report the outcomes of active surveillance (AS) for low-risk prostate cancer (PCa) in a single-center cohort. Patients and Methods: This is a prospective, single-center, observational study. The cohort included all patients who underwent AS for PCa between December 1999 and December 2020 at our institution. Follow-up appointments (FU) ended in February 2021. Results: A total of 413 men were enrolled in the study, and 391 had at least one FU. Of those who followed up, 267 had PCa diagnosed by transrectal ultrasound (TRUS)-guided biopsy (T1c: 68.3%), while 124 were diagnosed after transurethral resection of the prostate (TURP) (T1a/b: 31.7%). Median FU was 46 months (IQR 25–90). Cancer specific survival was 99.7% and overall survival was 92.3%. Median reclassification time was 11.2 years. After 20 years, 25% of patients were reclassified within 4.58 years, 6.6% opted to switch to watchful waiting, 4.1% died, 17.4% were lost to FU, and 46.8% remained on AS. Those diagnosed by TRUS had a significantly higher reclassification rate than those diagnosed by TURP (p < 0.0001). Men diagnosed by targeted MRI/TRUS fusion biopsy tended to have a higher reclassification probability than those diagnosed by conventional template biopsies (p = 0.083). Conclusions: Our single-center cohort spanning over two decades revealed that AS remains a safe option for low-risk PCa even in the long term. Approximately half of AS enrollees will eventually require definitive treatment due to disease progression. Men with incidental prostate cancer were significantly less likely to have disease progression.

Sarah Hagmann, Venkat Ramakrishnan, Alexander Tamalunas, Marc Hofmann, Moritz Vandenhirtz, Silvan Vollmer, Jsmea Hug, Philipp Niggli, Antonio Nocito, Rahel A. Kubik-Huch, Kurt Lehmann, Lukas John Hefermehl

Cancers

12.01.2022

LinkDOI