Talk:Prostate cancer screening

Now the PHI is approved shouldnt we mention it under alternative methods

Now the Prostate Health Index (The Prostate Health Index: a new test for the detection of prostate cancer) is approved shouldn't we mention it under alternative methods (and in the intro) ? - Rod57 (talk) 13:02, 30 December 2017 (UTC)

Painful biopsies?

While there is some much needed critical discussion of PSA screening compared to the main article on prostate cancer (which essentially says that screening is bunk), this article also repeats the canard that biopsies are high-risk, painful, etc. This is not true. I've had 3 biopsies, with 58, 17, 1nd 21 samples taken. The first had 46 perineal and 12 via the rectum, the second only perineal, and the third only rectal. All cases were one night in hospital. After the fist one, I went to a concert on the day I was released. The rectal one was the easiest: I had slight discomfort, not even pain, for about an hour after waking up from the anesthesia. Many, many, many, perhaps even most, patients who dies of prostate cancer die because they have heard false information about how dangerous a biopsy is and hence wait too long. — Preceding unsigned comment added by 193.29.81.232 (talk • contribs) 11:01, 8 January 2018 (UTC)

Thankfully, that seems to have been removed. And your point is spot on. Imagine if we went all hysterical over what women endure every year with a gyn exam. I was there, in the room. There was absolutely nothing painful about my husband's biopsy, and while it was intrusive, I found it much less intrusive than an annual pap smear. At least he got to be on his side, while women get to spread eagle. And while biopsy may provoke anxiety ... well, cancer does that, and you are not having a biopsy unless cancer is suspected. SandyGeorgia (Talk) 19:09, 3 March 2018 (UTC)

Not addressed

Doc James, the issues I raise for example with this edit have not been addressed. This article prioritizes ONE guideline (an old one) over many others (why?), the lead does not sufficiently address the controversy, or mention that screening saves lives, and African Americans are not even mentioned in the lead. Stating that "two methods are used" (DRE and PSA) is completely useless info, since they are optimally used together, not separately.

And HOW on earth do we have an article on prostate CANCER screening where the NCCN guidelines are not even mentioned, best I can tell. The impression from this article is that screening is not done-- not that men are encouraged to discuss it with their doctor and make an informed decision, weighing risks and benefits.

Yes, there is controversy with poor use of PSA screening (because of men freaking out over a Gleason 6 and demanding treatment, for example, or demanding biopsies based on PSA only with no DRE findings), but nonetheless, you will find plenty of reliable medical sources acknowledging that screening saves lives, and that is not mentioned in the lead.

This is not an article that should be casually or quickly edited, because the incomplete and incorrect information it presents is dangerous. Unless the article is going to be fully corrected to reflect the complete nature of the issue and the controversy, please leave my warning at the top of the article so our readers can at least access an accurate article before they decide to ignore their doctor's recommendations, or go away with the impression that all screening is discouraged. Where in this article, and in the lead, is information that screening saves lives? The lead biases one side of the controversy, in a way that is dangerous to men's health.

What most of the guidelines share in common is that men should be able to make an informed decision. What Wikipedia says is pretty much that men should not be screened at all. Two different things. And in direct contradiction to NCCN. SandyGeorgia (Talk) 07:08, 18 February 2018 (UTC)

I added that some do recommend screening in this edit.[1] Doc James (talk · contribs · email) 12:52, 2 March 2018 (UTC)

POV

The majority of this article presents all the evidence against screening and this content is located at the top of the article. It reads like an essay. I tagged it. Best Regards, Barbara (WVS) ✐  ✉ 20:46, 27 February 2018 (UTC)

This article is still biased; I will check back in later, and tag it if not corrected, based on discussion at WT:MED. The prose is also so garbled that it is hard to understand what the article is intending to say. SandyGeorgia (Talk) 10:01, 3 March 2018 (UTC)

Updated, MEDRS content

• Ref #41 can be replaced with: https://www.ncbi.nlm.nih.gov/pubmed/24267166/

Barbara (WVS) ✐  ✉ 21:51, 27 February 2018 (UTC)

• Rodriguez, Joseph F.; Eggener, Scott E. (March 2018). "Prostate Cancer and the Evolving Role of Biomarkers in Screening and Diagnosis". Radiologic Clinics of North America. 56 (2): 187–196. doi:10.1016/j.rcl.2017.10.002. ISSN 1557-8275. PMID 29420975.
• Tabayoyong, William; Abouassaly, Robert (October 2015). "Prostate Cancer Screening and the Associated Controversy". The Surgical Clinics of North America. 95 (5): 1023–1039. doi:10.1016/j.suc.2015.05.001. ISSN 1558-3171. PMID 26315521.
• Bryant, Richard J.; Lilja, Hans (May 2014). "Emerging PSA-based tests to improve screening". The Urologic Clinics of North America. 41 (2): 267–276. doi:10.1016/j.ucl.2014.01.003. ISSN 1558-318X. PMC 3989548. PMID 24725489.{{cite journal}}: CS1 maint: PMC format (link)
• https://www.ncbi.nlm.nih.gov/pubmed/29472826

I found the above three articles by searching for reviews during the last five years, in core clinical journals only, with these key words: "Prostate-Specific Antigen/blood"[MAJR] AND "Mass Screening/methods"[MAJR] (which should find only reviews that are primarily about the use of the PSA test specifically as a screening tool). Perhaps they would be useful for building an article that reflects the latest mainstream medical view on the PSA test. WhatamIdoing (talk) 00:34, 28 February 2018 (UTC)

Thank you. References are like candy (strange, I know). Best Regards, Barbara (WVS) ✐  ✉ 16:11, 28 February 2018 (UTC)

Gah

We have this "Potential benefits of screening stem from early detection; decreasing rates prostate-cancer specific mortality and metastatic disease, and increasing detection of localized cancers (better prognosis)."

Ref however says "Only one of five randomized controlled trials of PSA screening showed an effect on prostate cancer-specific mortality, and the absolute reduction in deaths from prostate cancer was one per 781 men screened after 13 years of follow-up. None of the trials showed benefit in all-cause mortality, and screening increased prostate cancer diagnoses by about 60%. Harms of screening include adverse effects from prostate biopsy, overdiagnosis and overtreatment, and anxiety."

That is not an accurate summary of the source. Doc James (talk · contribs · email) 13:54, 2 March 2018 (UTC)

References

Magnetic imaging section

Does not use MEDRS sources and is dubious. Article concerns should go beyond the lead. [2] This is a very short article—it should at least use secondary reviews. SandyGeorgia (Talk) 10:58, 3 March 2018 (UTC)

• Is this of any use? Little pob (talk) 16:32, 3 March 2018 (UTC)
  • Thank you, but that source does not meet MEDRS. It is an advocacy organization. In the US, there are efforts to get MRI-guided biopsy covered by medicare and insurance, so we have to take care with advocacy. I am unaware of a good MEDRS source for this text, but anecdotally, no physician we have spoken to at a top-rated NCCN research and teaching hospital has indicated support for this claim. A secondary review should be located. I am told—-again, this is anecdote—-that MRI guidance is sometimes better, sometimes not. SandyGeorgia (Talk) 16:49, 3 March 2018 (UTC)

Here is an example of what is going on in the US. http://drgeo.com/how-to-get-your-prostate-mri-covered-by-your-health-insurance/

And here is a primary source example of research underway. Although it cannot be used in the article, it gives helpful explanations of the state of the art. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503963/

I do not fully understand what is going on in the UK, but I imagine their demographics and economics are different than the US. In the US, something like 10,000 baby boomers per day are turning 65, enrolling in medicare, about half of those are men, 1 in 6 will have prostate cancer, 12% of those will die of prostate cancer, and 66 is the average age of detection. All this means that the US has a ticking time bomb of pending cancer death among baby boomers, whose detection and treatment will be paid by taxpayers, thanks to the USPSTF expansion of power under Obamacare.

If Wikipedia had an article on a condition affecting women in a similar state, the gender police would be all over it. SandyGeorgia (Talk) 18:59, 3 March 2018 (UTC)

Biopsy section is incomplete

MRI guided techniques ‘’’has’’’ improved the diagnostic accuracy of the procedure. Biopsies can be done through the rectum or penis.

Techniques has? Missing hyphen? Biopsy may de done through the rectum, or the perineum, or the penis ... but this information is not very useful if not also mentioning that transrectal is by far the most common, and that biopsy is also typically ultrasound guided (this article implies that MRI guided is more common). MRI-guided biopsy is not covered by most insurance because it is not yet proven useful generally (at least that is what we were told anecdotally). Better research and sources needed. I am unaware of when the more rare biopsy is done through the penis or perineum, but it might help to flush that out. SandyGeorgia (Talk) 17:55, 3 March 2018 (UTC)

New testing trial in UK news (3 March 2018)

(I thought it best to put this in talk as there isn't a research section, and, given WP:NOTNEWS and WP:MEDPOP, I'm not sure if it's even appropriate to add this to the article?)

A new "one-stop" service for prostate cancer testing has made the UK news today. It's a 2 year study focused on performing mpMRI scans prior to a TRUS biopsy. The scan and any biopsy (if needed) would be done on the same day, or a relatively short time afterwards, with the MRI images being used to help target any relevant prostate lesions. (Stereotactic surgery?)

The story seems to have broken in Daily Mail; but per WP:DAILYMAIL, here are links for other sources: BBC and The Times (paywalled). Little pob (talk) 17:21, 3 March 2018 (UTC)

We do not add medical news to Wikipedia; Wikipedia is not a newspaper. Thanks. Jytdog (talk) 17:28, 3 March 2018 (UTC)

Thanks for confirming. Little pob (talk) 17:43, 3 March 2018 (UTC)

(edit conflict) I see no usefulness in adding this information, NOTNEWS, and the source does meet MEDRS. (Besides that, the idea seems wacky ... I am aware of no reliable source or reputable practitioner claiming that six weeks delay matters in prostate cancer detection and treatment. Is the NHS that goofy?) And BBC, really? "Currently a test for men with prostate cancer requires an MRI scan and a biopsy where a dozen samples are taken, requiring multiple hospital visits." It does not require an MRI, and it does not require multiple visits, and in the US, it does not require a hospital visit. And the "dozen samples" happen in one biopsy. This kind of crappy laypress reporting is why we don't use the laypress. (Johnbod what on earth is the NHS thinking? They don't want PSA screening, but they will jump to a very expensive and unnecessary modality?) SandyGeorgia (Talk) 17:49, 3 March 2018 (UTC)

Unused secondary reviews

• PMID 27995937 (Well, yes, reading through the ENTIRE article-- not just the abstract-- is a slog, but anyone who hasn't, should not really be adding biased edits here .. this article can be viewed in conjunction with the newer Catalona, PMID 29406053 ... without this content, we have a non-neutral article.)
• PMID 28977112
• PMID 28725588
• PMID 28725585
• PMID 28725580

SandyGeorgia (Talk) 00:04, 5 March 2018 (UTC)

SandyGeorgia I understand this is a difficult time for you, but please stop leaving edit notes like the one that you did with the message above, and please do deal with all the sources. A pubmed search for reviews gives

• PMID 26389383 (PDQ) which is quite negative about screening with PSA
• PMID 29472826 which is about the more recent tests that have come out because PSA is so crappy and leads to too many followup procedures and treatment

We just don't have good ways of screening for aggressive vs indolent prostate cancer. It is not as bad as the ovarian cancer or pancreatic cancer situations but it is not good. That is just where the science and medicine is. Jytdog (talk) 01:58, 5 March 2018 (UTC)

My edit summary said bias ... could you explain better why you object to that? I have exercised restraint so far in not tagging the articles. Choosing one set of sources, and excluding others, is bias. I would correct it myself if not for being involved in treatment, because it is really not rocket science to do this right. It is also quite hard to edit and enter edit summaries from a tablet. SandyGeorgia (Talk) 02:19, 5 March 2018 (UTC)

You are really asking for a response. Please see your talk page. Jytdog (talk) 18:25, 5 March 2018 (UTC)

You did not answer the question.[3] SandyGeorgia (Talk) 19:08, 5 March 2018 (UTC)

Baseline at an early age

Removing this text about recommendations for baseline testing was warranted because it was poorly sourced and in the wrong place. But although I provided a source for this or similar text yesterday (in the section just above this one), there is now no mention of baseline testing recommendations starting at age 45, in spite of PMID 27995937 above. A thorough read of all of the sources would probably make for less piecemeal editing; it can be difficult for those not immersed in or experiencing a condition to be aware of what they are unnecessarily removing. When you are not yet sure if a sentence can be sourced, then tagging it with cn is more useful than removing the text. If a man has no baseline screening, then PSA results becomes difficult to interpret, and you lose time towards cancer detection or end up with unnecessary treatment. This is covered in the source I provided above, so this text should have been adjusted, not removed. Please, friends, take greater care to understand all sources when editing this topic that affects so many men.

Jytdog, have you seen my question above about my edit summary? I would still like to understand why you object. SandyGeorgia (Talk) 18:16, 5 March 2018 (UTC)

Quackguru, thanks for taking the time to clean this up and expand it, but this is pretty close paraphrasing. I am not good at correcting too close paraphrasing, so perhaps you or someone else will recast this sentence:

• Source [4]

• Other guidelines recommend starting at age 45, due to growing evidence that an elevated baseline PSA can be predictive of future lethal disease.

• Wikipedia [5]

• Other guidelines and centers specializing in treating prostate cancer recommend obtaining a baseline PSA in all men at age 45, due to emerging evidence that an increased baseline PSA can be used to detect future deadly disease.

We can't maintain the same sentence structure, and just change three words (growing --> emerging; elevated --> increased; lethal --> deadly). I appreciate that you at least reviewed the source, though, to see that it mentions guidelines and cancer centers. Regards, SandyGeorgia (Talk) 19:23, 5 March 2018 (UTC)

Thanks for that, Quackguru ... I am not wedded to my version, but we have to also alter sentence structure, so I gave it a try. [6] SandyGeorgia (Talk) 19:37, 5 March 2018 (UTC)

I was about to split it into two sentences, but I got an edit conflict. Now I am done. See "Other guidelines and centers specializing in treating prostate cancer recommend obtaining a PSA in all men at age 45.[33] This is based on emerging data indicating that an increased baseline PSA can be used to detect future deadly illness.[33]" QuackGuru (talk) 19:49, 5 March 2018 (UTC)

Ok, thanks, and sorry for the edit conflict (I like to get on paraphrasing quickly, lest we forget). SandyGeorgia (Talk) 21:01, 5 March 2018 (UTC)

COI sources

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Per this, I'm wondering are editors considering conflict of interest, when considering sources? Of course a COI does not disprove a source, but it does warrant caution. I'm not prepared to edit this article or comment on what is the most reliable sources as it is outside my knowledge area. I'm just a little concerned about whether harmful biased information, with the best of intentions, could be, or is being, added to this article with the potential to cause a lot of harm to guys like me. I'm academically ignorant of this subject matter and have a concern (which may be unfounded) that I am querying. Thanks.--Literaturegeek | T@1k? 02:08, 6 March 2018 (UTC)

Here is how to correctly use that source. First, it explains quite well what is going on with prostate cancer screening. Second, there are scores of sources that explain the same. Read Catalona, ignore that his COI may be a factor, use his article to understand the problem, then use the many other sources that explain same to fix the article. Example: can you dispute Catalona that there are no urologists or oncologists on this board? Can you dispute that the role of this task force changed under Obamacare? You cannot dispute that there are sources that backup the actual problems with the data, as Catalona explains, because that same info can be found in a number of sources. Summary: read, digest, understand what Catalona is saying, because he puts it all in one place. But also read everything else. We have a few proponents of one POV wanting to exclude all other from these articles. Use Catalona to understand what is being excluded, then use other sources that may not explain the issue as well as Catalona does to source text. And, there are some issues that can be sourced to Catalona even with COI (e.g. the makeup of the task force body, etc.)

The problem here is that we have some rational beings who apparently won't even read Catalona to understand exactly what the best prostate cancer people in the world, in the best prostate cancer treating facilities in the world, all know. Because none of the top treating prostate cancer groups in the US hold the same POV that Wikipedia is espousing and endorsing, Wikipedia can choose to ignore reliable sources and be on the wrong side of prostate cancer deaths, or Wikipedia can choose to write an article that correctly reflects all POVs, and hold itself as a neutral observer of the controversy, rather than a contributor to it. THAT is the role that good editors should be playing, rather than vociferously arguing for ignoring some sources to maintain a POV article. Catalona says nothing that cannot be found in other sources-- he just happens to wrap it up nicely in one article.

Further, we all only need to look up on this talk page, to this discussion, to see that discussion of sources works better than editing articles too fast, without knowing all that is out there in ALL sources. I have been accused of bringing my personal situation to these discussions. Well, yes. Because I am living with the USPSTF mistake, and I have read secondary reviews quite extensively, and I knew portions of that text were accurate, even if not yet correctly sourced. Yes, I bring the personal ... I am immersed in these sources as a matter of fact now. People, stop insisting on one POV over another, and start listening to each other. There are many many sources ... prostate cancer is a leading medical issue for men, and a cash cow, hence a complex topic. You cannot broad brush it, fix only the lead, or fix the article based on a cursory understanding of prostate cancer. SandyGeorgia (Talk) 17:20, 6 March 2018 (UTC)

Oops, another point for LitereatureGeek before I hit the road. Reading Catalona will help you understand that there are broadly three different approaches to detecting and treating prostate cancer. One, for those on Medicare. Two, for those who have insurance other than or beyond Medicare. Three, for those who can afford to pay for their own care. As of now, for a cancer that affects a huge number of men, we have no one gold standard for detection or treatment, and we have patients who do not have access to some proven methods; we can hope these issues will get settled somewhere down the road. For now, they are not.

Meanwhile, reputable treating physicians still know what works (hint: not USPSTF recommendations).

To understand just how complex this mess is, look at the situation in the UK. NHS won't endorse (inexpensive) screening across the board, but now there will be same-day (expensive) screening in the UK using MRI, which is not paid by most insurance in the US. Same day, what the heck? MRI, holy cow! No such thing in the US (we couldn't have an MRI because our insurance won't pay it), yet the UK jumps straight to it, while discouraging less costly screening. NHS employs a methodology that is not yet proven, and available in the US to those who can pay for their own care. (Our Dr. recommended against, even if we paid for it ourselves. His logic was that it was an unproven methodology, that we would be paying out of pocket, and that he had no confidence that it would do a better job of detecting the cancer which he could already feel on very inexpensive Digital Rectal Exam.) Catalonia's article, regardless COI, lends understanding to the economic problem that is driving down screening, resulting in more advanced cases of cancer being detected. SandyGeorgia (Talk) 18:32, 6 March 2018 (UTC)

That (MRI & same-day biopsy) is just an experiment in I think 3 hospitals, Sandy. The NHS doesn't do mass screening, and given the new results of a massive trial announced this week (see below) isn't even moving in that direction, but will do tests for individuals who request it or whose symptoms lead their GP to suggest it, after their GP has set out the pros and cons. Johnbod (talk) 03:09, 8 March 2018 (UTC)

Thanks, Johnbod-- I had asked you above what on earth they were thinking (expensive MRI and same day, yes, but inexpensive PSA, no), but you may have missed that post. I am still trying to imagine what they will do if their experiment gives good results-- offer MRI to everyone as the standard? If detection of prostate cancer by MRI becomes the standard, it will really be expensive, and I wonder what that will do to Medicare's costs in the USA. SandyGeorgia (Talk) 17:01, 8 March 2018 (UTC)

User:SandyGeorgia, I don't really know - I usually look first to my old workmates who do the CRUK science blog for sensible information and analysis on cancer news, but so far they have been silent on this. The best info I can find now is the NHS press release, which of course all the papers parrot], and which doesn't fully answer the questions. It is just 3 hospitals (all very local to me). Johnbod (talk) 18:30, 8 March 2018 (UTC)

I typed up a reply and lost it when browser refreshed for no rational reason, ugh. Here goes again. Your suggestion, Sandy, to use the Catalona review to give a general overview of the controversy seems sensible and I see no reason why it can't be cautiously cited in the article alongside POVs that may differ from Catalona. I think the issue here is WEIGHTing the sources. It is very unfortunate you are affected by this in your real life and I hope your husband gets the best medical treatment possible and recovers soon.--Literaturegeek | T@1k? 13:15, 7 March 2018 (UTC)

Thanks for the well wishes for recovery, Literaturegeek ... we do have the best care possible as we fortunately live within driving distance of a top-rated NCCN teaching hospital and facility. My first tipoff to the problems in these articles was that NCCN guidelines were not even mentioned a few weeks ago, and they reflected almost none of my reading in secondary reviews, books, or in literature given to us at the hospital.

Cure is achievable until cancer escapes the prostate. There is no cure once cancer escapes the prostate. After that, the word "recover" doesn't really apply ... it becomes a matter of calculating your life expectancy and then choosing from an array of treatment options that you hope will allow you a decent quality of life for your remaining years. That is, "pick your poison" from various intended or side effects (urinary incontinence, fecal incontinence, erectile dysfunction, mood swings, depression from male castration, and so on) and hope that whichever option you pick for treatment does not leave you with side effects that will make your remaining years not worth living.

So, there is still so much missing in our articles. In bringing this suite of articles up to snuff, we have to remember that the whole story is not told by life expectancy statistics; it is about how miserable or not your remaining years will be when the cancer is detected too late. It is a challenging topic and it could be fun to bring the articles up to snuff if everyone would set aside ego, entrenchment, and use the talk page as in the example I gave above. We cannot fix this suite of articles quickly. Best, SandyGeorgia (Talk) 14:06, 7 March 2018 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Zero impact journal

This text "Prostate cancer screening provides the ability to greatly lower death and disease."

First the journal has a zero impact factor.[7]

Secondly even if it was a respected journal "significantly reduce morbidity and mortality" is talking about statistics and does not equal "greatly". Doc James (talk · contribs · email) 12:18, 6 March 2018 (UTC)

New mass study results in UK

The new results of a very large (over 400,000 participants) study in the UK are getting a lot of publicity here, and the wind is blowing against mass screening. Note the study covered one-off tests only (then follow-up depending on the initial results). I wonder if our articles are as careful as they should be in saying what the type/frequency of screening studied was? The easiest way in is this Cancer Research UK science blog entry, and here's the JAMA paper. That CRUK graphic could be used in the article, btw. Johnbod (talk) 16:51, 7 March 2018 (UTC)

RE "our articles are as careful as they should be in saying what the type/frequency of screening studied was", our articles are not carefully explaining, yet, anything about how screening is applied, or misapplied. They are no longer dangerously representing only one outdated POV, but they aren't yet anywhere near complete. As long as they are no longer dangerous, I think that's the best we can hope for with Wikipedia.

It will be interesting to see how this UK primary study pans out under secondary review ... for example, I cannot imagine how one-off testing could work. If we had had only one-off testing, and only follow-up based on initial results, my husband would today have undetected moderately aggressive prostate cancer, because he had four normal PSAs before the spike. We are glad he had more than one PSA :)

Moving towards "one-off" or no testing means prostate cancer will not be detected until the tumor is palpable on Digital Rectal Exam, which is not good ...unless the NHS thinks they can replace inexpensive PSA screening with expensive MRIs for everyone ... maybe the economics of healthcare in the UK are different than in the US. SandyGeorgia (Talk) 17:09, 8 March 2018 (UTC)

We will not add content about news; has otherwise developed into chatting and this is not a forum Jytdog (talk) 20:10, 8 March 2018 (UTC)}

I think we should discuss how to mention this study in this article. This is an enormous, high-quality study, and it is exactly the kind of thing that MEDRS's statements about "large randomized clinical trials with surprising results" is intended to cover. While we wait for proper reviews, the results from this massive study is worth mentioning. My initial thought is that the mention should closely follow the MEDRS example, copied here for the convenience of people who don't have it memorized:

"A large, NIH-funded study published in 2010 found that selenium and Vitamin E supplements, separately as well as together, did not decrease the risk of getting prostate cancer and that vitamin E may increase the risk; they were previously thought to prevent prostate cancer." (citing PMID 20924966)

(SandyGeorgia will probably remember that Eubulides had written a far shorter and simpler example back in the day, but this is the current one.) In this case, it would probably look something like this:

"The largest-ever study of PSA tests, published in 2018, found that offering a single PSA test to men in their 50s and 60s somewhat increased the likelihood of being diagnosed with low-risk prostate cancer, but did not change their risk of dying from prostate cancer during the next ten years." (citing the JAMA paper)

We could, if wanted, specify that "very large" means more than 400,000 men. I do think that it's important to clearly state that the test looked at the long-term effect of offering only a single PSA test to men in the target age range, rather than annual screening. We could also point out that the risk of dying in this group was already low (ACS gives the 10-year survival as 98% overall).

This is the largest-ever study on the subject, and the result doubtless surprised and dismayed people who favor PSA testing (or who favor screening and assume that PSA testing is the only/best way to screen). The study itself may actually be WP:Notable. Is there any good reason not to mention its existence? WhatamIdoing (talk) 02:33, 10 March 2018 (UTC)

"enormous, high-quality study," is your judgement, as is what to emphasize out of it. That is what we use secondary sources to tell us. There is no hurry. Jytdog (talk) 05:47, 10 March 2018 (UTC)

Source

It has been suggested to use this page from cancer.gov as a source. Jytdog (talk) 06:47, 10 March 2018 (UTC)

Model

My apologies if this has already been offered, but this page looks like the way we need to write this article for it to be comprehensive, updated, accurate and neutral (relative to US) ... it covers the controversy, explains what part of PSA screening is controversial and why, discusses current use, and discusses the rest of the stuff that the Wikipedia article is completely missing (like how to use PSA during watchful waiting and after prostatectomy, for instance).

Instead of using this sensible, reader-oriented page from cancer.gov, we are/(were) using a highly abbreviated health professional version which isn't very helpful. In fact, even using that abbreviated page when we have this comprehensive page from the same source smells like cherry picking. https://www.cancer.gov/types/prostate/psa-fact-sheet

This model shows that writing this article with all caveats and all POVs should not be that hard. Notice that it distinguishes between over diagnosis and over treatment (something people mix up on this talk discussion). If we could all read this article and decide if there is anything in it we strenuously object to AS A MODEL, perhaps then we could dispense with a gazillion RFCs, arguing sentence by sentence while the articles are overall horrid, and have a direction in which to work. TOGETHER. For men's lives' sake. Then we have to make sure to add in non-US (there are loads of secondary reviews about how PSA screening is used in other countries). SandyGeorgia (Talk) 19:18, 8 March 2018 (UTC)

I think there are some advantages to that model. However, there are a few things we'd have to leave out, especially on using the PSA test to follow survivors. Here's the structure that I see on that page:

• What is the PSA?
• Efficacy (does it work/is it recommended) for screening
• Results/how to interpret
• What happens if you get "bad" results
• Limitations and harms
• Research

The main difficulty I think we would have is that cancer screening ≠ PSA-based cancer screening, and that page is pretty focused on PSA testing. WhatamIdoing (talk) 02:43, 10 March 2018 (UTC)