Talk:Prostate cancer

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Too US-specific

Much too much emphasis is put on the idea the PSA screening is a bad idea. Repeating this can kill people. This erroneous claim is based on a study in the USA which showed no difference in survival rates between screened and non-screened. But it turned out that those in the control group also did screening. The idea that screening should be avoided due to over-treatment is absurd. No-one is forced to undergo treatment. No-one is forced to undergo a biopsy (though this is relatively harmless and it would be silly to refuse this if the PSA value and its rate of increase suggest cancer). This is mentioned, with references, at https://en.wikipedia.org/wiki/Prostate_cancer_screening so it seems strange to have a critical discussion there and repeat the old canard here. — Preceding unsigned comment added by 193.29.81.232 (talk) 10:52, 8 January 2018 (UTC)

When metastatic

doi:10.1056/NEJMra1701695 JFW | T@lk 12:19, 8 February 2018 (UTC)

2018 position

NCI says in Feb 2018

"The issue of prostate cancer screening is controversial. In the United States, most prostate cancers are diagnosed as a result of screening, either with a PSA blood test or, less frequently, with a digital rectal examination. Randomized trials have yielded conflicting results.[16-18] Systematic literature reviews and meta-analyses have reported no clear evidence that screening for prostate cancer decreases the risk of death from prostate cancer, or that the benefits outweigh the harms of screening.[19,20]"

Have removed the 2013 Cochrane review as I agree it is old. And it is not needed. Doc James (talk · contribs · email) 14:20, 1 March 2018 (UTC)

It is irrelevant it is controversial. It does not tell the reader much. It may also be dangerous for our readers because readers may skip prostate screening or getting a second opinion after reading that. QuackGuru (talk) 16:36, 2 March 2018 (UTC)

POV

This is a POV edit, that cherry picks (mines) one source for one negative statement, and ignores the overall. It also removes reliably sourced information, with no discussion. I will tag the article as POV if these issues (and others outlined at WT:MED) go uncorrected for more than a few days. Doc James, you cannot just run through articles under discussion,[1] doing with them as you wish. Please discuss. SandyGeorgia (Talk) 17:34, 1 March 2018 (UTC)

I have joined this discussion with the above. The discussion regarding this article should be occurring here.

Lets go through the sentences one by one if you wish. Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)

Lets stop waiting time by going through each sentence with the wrong version. SandyGeorgia and I have a clear problem with the old version. Is there any other editor supporting the old version? QuackGuru (talk) 16:36, 2 March 2018 (UTC)

Sure so try a RfC and we can both present our sides and vote on it. If we contain content inline with the CDC, NCI/NIH, Cochrane, and USPSTF for a little longer it is not a big deal. Cancer always sucks but that does not mean we must now ignore a bunch of major sources. Doc James (talk · contribs · email) 04:00, 3 March 2018 (UTC)

Both User:SandyGeorgia and I disagree. Does anyone else support the current wording? We should not ignore what other sources say that give more helpful content for a concise lead. QuackGuru (talk) 15:34, 3 March 2018 (UTC)

Sentence 1: Is PSA testing controversial?

Currently we say "Prostate cancer screening is controversial."

This is supported by a 2018 statement by the NCI the devision of the National Institutes of Health specifically for cancer. It is also supported by the World Cancer Report by the World Health Organization. Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)

Again, it is irrelevant it is supported by the citation. We should focus on content that benefits our readers. This content does not benefit our readers. QuackGuru (talk) 16:36, 2 March 2018 (UTC)

Telling readers that the medical community is divided on this issue is very useful. There is no "one truth" on this Doc James (talk · contribs · email) 03:59, 3 March 2018 (UTC)

Telling readers prostate cancer screening is controversial is like telling them it is bad or even not that useful. That is not useful. There is better information on this. QuackGuru (talk) 15:34, 3 March 2018 (UTC)

I am OK with telling our readers that it is controversial, as long as we explain that the reason that it is controversial largely points back to the flaws in the USPSTF recommendations. That issue is very widely understood by urologists, and is explained quite well by Catalona. We should be concerned, at Wikipedia, that we are supporting and furthering a recommendation that has been shown for several years now by reliable sources to be flawed ... to the extent that the USPSTF had to back down. Catalona is not the only physician explaining that in MEDRS sources. Just saying it is controversial does not add much. The concerns are in multiple areas, and we do not distinguish. 1. Men are running around getting biopsies when they don't need them (that is an education issue). 2. Unscrupulous practitioners are offering, for example, radical prostatectomy for Gleason 6s. That is an ethical issue. 3. Because of 1 and 2, unnecessary treatment happened. Then the USPSTF caused a decline in screening, which leads to a decrease in detection of treatable cancer, and an increase in non-organ-confined disease. If you do not explain the specific controversy (which sources do well, try reading Catalona if you don't yet understand the problem), it sounds like the problem is with the PSA test per se, rather than how it is correctly or incorrectly applied. Also, as long as this article does not do this correctly, it is too US centric, since the European study got it right. SandyGeorgia (Talk) 17:09, 3 March 2018 (UTC)

Please base discussion on what MEDRS sources say about medical decision making and what RS say about ethics; we of course need to apportion weight among reliable sources. In my view we should give less WEIGHT to a ref calling for more testing by people with a financial stake in more testing. The disclosure is on the paper to inform that kind of consideration. Jytdog (talk) 17:25, 6 March 2018 (UTC)

I have provided multiple sources that say the same as Catalona throughout talk page discussions on various articles in the prostate cancer suite. Catalona is not the only one explaining the problem: he just happens to wrap it all up nicely in one article. SandyGeorgia (Talk) 16:56, 8 March 2018 (UTC)

Sentence 2: Does it change the risk of death from prostate cancer?

Currently we say "Prostate-specific antigen (PSA) testing increases cancer detection but it is controversial regarding whether it changes the risk of death from the disease."

All agree that PSA testing increases the risk of cancer detection. Some sources say it decreases the risk of death from prostate cancer well other sources says it does not. Saying that its effect on death from the disease is controversial IMO is accurate.

Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)

The content is misleading because early detection saves lives. QuackGuru (talk) 16:36, 2 March 2018 (UTC)

No it is controversial. We have excellent refs which say it does not save lives. Doc James (talk · contribs · email) 03:58, 3 March 2018 (UTC)

Early detection reduces mortality, especially for those who have a long life expectancy. QuackGuru (talk) 15:34, 3 March 2018 (UTC)

Doc James, we have sources that say both. We are stating as fact something that is not fact. It is possible to say both. You want to preference one source over others. And if you talk to urologists who are engaged in the heart of this very research and controversy, you (and Wikipedia) are going to find yourselves on the wrong side of history in the not-too-distant future, because men are not going to keep silently suffering because of a misguided governmental action that resulted from Obamacare. SandyGeorgia (Talk) 17:12, 3 March 2018 (UTC)

Most of the recent sources say their is a small decrease risk of death from prostate cancer but due to overdiagnosis and over treatment it is unclear if it improves overall risk. Have adjusted to match that. Doc James (talk · contribs · email) 12:14, 5 March 2018 (UTC)

Sentence 3: Informed decision making

This is what we currently say "Informed decision making is recommended when it comes to screening among those 55 to 69 years old." This is somewhat US centric but IMO is not unreasonable.

Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)

We should try to find another source for screening under 50 years of age to replace the current wording. QuackGuru (talk) 16:36, 2 March 2018 (UTC)

Why? Doc James (talk · contribs · email) 03:58, 3 March 2018 (UTC)

This is the same organization that was previously against screening. They recommend informed decision making rather than encourage screening. Early detection reduces mortality, especially for those who have a long life expectancy. Cancer can be diagnosed earlier before it spreads. QuackGuru (talk) 15:34, 3 March 2018 (UTC)

Why? Catalona explains it. There are plenty of reliable sources, and in practice, many urologists call for baseline screening when a man is in his 50s. Anecdotally (personally), I will explain why. My husband's 2.97 was cancer. Another man's 2.97 may not be cancer. If you don't establish a baseline, it can be harder down the road to know when a biopsy or more careful scrutiny is needed. Catalona explains that. Other sources explain that. Urologists know it.

And, we need to take greater care to address the higher-risk populations in the lead, because they are the people most likely to be consulting this article (PCa in family history, or African-American). It is not to difficult to add a few qualifying words to that sentence to make it clear it applies only to some populations. SandyGeorgia (Talk) 17:17, 3 March 2018 (UTC)

Additional details

Wondering peoples thoughts on this?

"Testing, if carried out, is more reasonable in those with a longer life expectancy.

Cabarkapa, Sonja; Perera, Marlon; McGrath, Shannon; Lawrentschuk, Nathan (December 2016). "Prostate cancer screening with prostate-specific antigen: A guide to the guidelines". Prostate International. 4 (4): 125–129. doi:10.1016/j.prnil.2016.09.002."

Doc James (talk · contribs · email) 11:43, 2 March 2018 (UTC)

I think it might be a problem if the article is excessively reliant on US material. Different countries may weigh risk/benefit analyses differently, for one thing. Jo-Jo Eumerus (talk, contributions) 11:44, 2 March 2018 (UTC)

User:Jo-Jo Eumerus this is an Australian source. It also comments on conclusions in other countries with

"The consensus from recommendations from other parts of the world is geared against a routine test for PCa using a PSA test. In general, the view that routine PCa testing is not recommended is held by the American Academy of Family Physicians and The US Preventive Services Task Force. More specifically, The American Urological Association (AUA) recommends against PCa screening in men aged < 40 years and in men aged ≥ 70 years with a life expectancy of < 10 years. Furthermore, the AUA stance on asymptomatic men is that the greatest benefit of routine screening can be found in men aged 55–69 years."

Doc James (talk · contribs · email) 11:46, 2 March 2018 (UTC)

The greatest benefit is different for each individual. Bundling every person into an age group is very dangerous. QuackGuru (talk) 16:36, 2 March 2018 (UTC)

If you talking about "the greatest benefit of routine screening" you are obviously talking on a population basis. Disentangling the population view (screening) from the individual view (testing) is one of the big problems with these articles, as I have suggested on the project talk. Johnbod (talk) 16:41, 2 March 2018 (UTC)

General recommendations can be dangerous for an individual. We should not repeat unhelpful content in the lead when we know different people have different circumstances. I will focus on helpful content rather that irrelevant content such as stating it is controversial. QuackGuru (talk) 16:53, 2 March 2018 (UTC)

It is not our job to decide what is "helpful", rejecting everything else as "irrelevant". But as I say, we need a clearer view of the position for individuals, as opposed to the population issues involved in "screening". Overtreatment is also dangerous for the individual (though obviously it may not be as much so as lack of a diagnosis), and is one of the main objections to routine screening. Johnbod (talk) 17:04, 2 March 2018 (UTC)

A 2018 review states, "In the aftermath of the USPSTF recommendations, the widespread rejection of screening by many primary care physicians has had far-reaching consequences, notably, a reversion to more PCa cases being high-grade and advanced at diagnosis."

References

This and other pages repeated the previous USPSTF recommendations. We should not continue to repeat past mistakes. The previous USPSTF recommendations directly lead to high-grade cancer and premature death. Focusing on helpful content is a much better idea that continuing to state it is controversial. Stating it is controversial may promote the rejection of screening among our readers. QuackGuru (talk) 17:15, 2 March 2018 (UTC)

Were does the ref say "The previous USPSTF recommendations directly lead to high-grade cancer and premature death"? I am not seeing it?

The quote you give does not support that. Yes if fewer prostate cancer cases are diagnosed overall a greater proportion of those that are diagnosed are high grade. The question is about changes in absolute numbers.

The 2018 USPSTF says "The Task Force continues to find that the potential benefits and harms of screening are closely balanced."[2] Doc James (talk · contribs · email) 03:57, 3 March 2018 (UTC)

A "reversion to more PCa cases being high-grade and advanced at diagnosis"[3] directly or indirectly lead to high-grade cancer and thus premature death because "in the aftermath of the USPSTF recommendations, the widespread rejection of screening by many primary care physicians has had far-reaching consequences".[4] What where the consequences? Notably, "a reversion to more PCa cases being high-grade and advanced at diagnosis."[5] QuackGuru (talk) 15:24, 3 March 2018 (UTC)

In general terms, Doc James, because prostate cancer is typically slow growing, treatment is all about life expectancy. But, as Catalona points out, the average life of a 70-year-old man in the US will extend another 15 years, which makes detection of prostate cancer a concern even at 70. There are reputable surgeons looking at very healthy physically fit and active 70-year olds who are doing radical prostatectomy because those men have still good life expectancy, and for example, Memorial Sloan Kettering employs life expectancy tables in decision making. Certainly the NCCN hospital we are at does so as well-- they won't even talk treatment without involving life expectancy. And they, like you, would like to see the unscrupulous surgeons and operators shut down, but not by letting more men with legitimate cancer and good life expectancy die. Informed decision making over black-and-white thinking. Our article is black-and-white, and that is not how prostate cancer detection and treatment is addressed by experts (that is, once you get out of the hands of the dumb USPSTF-influenced GP, who would put you out to pasture to die.) This article will not be fixed by cursory editing-- in-depth knowledge and review of sources is needed-- of the sort Johnbod is capable. One in six-- I hope any man resisting corrections here is spared. It is possible to responsibly address the controversial aspects. SandyGeorgia (Talk) 17:26, 3 March 2018 (UTC)

We have a lot of sources that have come to the same position as the USPSTF including the World Health Organization, Cochrane, and the NHS.

We reflect their positions, the new draft statement form the USPSTF, as well as that of Catalona.

Even though prostate cancer is supper common most people who get it do not die from it. Doc James (talk · contribs · email) 12:25, 5 March 2018 (UTC)

Yes, the articles are better now because more positions are reflected than the deadly and outdated 2012 USPSTF source. Correct, most do not die from prostate cancer (but more do now as a result of USPSTF). And with reversion to more prostate cancer being detected when it is beyond the stage of cure (because of the decline in screening caused by the USPSTF), the issue is about quality of life lived rather than time lived. Focusing ONLY on life expectancy is not what treating urologists and oncologists do, and is a mistake in this article.

More men diagnosed at later stage means more of them will live with urinary incontinence, fecal incontinence, erectile dysfunction, and-- in the case of hormonal therapy-- mood swings, depression and the like. The article must deal with the whole story-- quality of life and life expectancy-- just as practicing urologists and oncologists do. Reliable sources do this, also. Please include in your reading base literature written by physicians as well as governmental sources. Many sources cover the full picture and explain what Catalona explains.

The problem with the proposed statement (above) is that it just doesn't say anything or add anything. SandyGeorgia (Talk) 16:53, 8 March 2018 (UTC)

Claim that USPSTF statement in 1996 has been harmful

New cases and deaths from prostate cancer in the United States per 100,000 males between 1975 and 2014

We have the graph here. We see a huge increase in cases of prostate cancer in the 80s and 90s as PSA testing became common. We than see a fall in new cases as screening becomes less common. USPSTF has been recommending against screening with PSA for prostate cancer since at least 1996.[6] Despite this deaths from prostate cancer has been steadily decreasing since the 1990s. Doc James (talk · contribs · email) 12:34, 5 March 2018 (UTC)

Doc, could you try not to put links in subject headings? This is very old interpretation of data, and original research on that data (which amounts to, a little bit of information is a dangerous thing). Catalona explains it. PMID 29406053 So does the other source I gave that explains same as Catalona. PMID 27995937 You also fail to notice that quality of life and life expectancy are not the same thing. That is, would you like to live for ten years with fecal incontinence? The entire story of prostate cancer is not told with life expectancy. That is why the sources discuss that USPSTF caused a reversion to more advanced cases being detected. Rather than trying to argue a POV, why not just make sure the article includes all sides of the controversy? It's not hard. SandyGeorgia (Talk) 00:44, 6 March 2018 (UTC)

Agree the whole story of prostate cancer screening is not told by life expectancy alone. Between 20 and 50% of cancers diagnosed are over-diagnosed. Many of these overdiagnosis result in a radical prostatectomy. "A meta-analysis of the harms of radical prostatectomy concluded that 1 man will experience substantial urinary incontinence for every 6 men who have a radical prostatectomy rather than conservative management (95% CI, 3.4 to 11.7) and 1 man will experience long-term erectile dysfunction for every 2.7 men who have a radical prostatectomy rather than conservative management (95% CI, 2.2 to 3.6)." Doc James (talk · contribs · email) 13:15, 6 March 2018 (UTC)

Doc, perhaps you can agree that there is a basic logical error in "overdiagnosis results(s) in a radical prostatectomy". It is not the diagnosis that results in over treatment. Yes, there are Gleason 6s running around hysterically demanding treatment, and there are unscrupulous practitioners preying on that irrational fear to make money. One in six men will be diagnosed with prostate cancer, and it is a cash cow. That there are fearful patients being operated on by unscrupulous physicians does not mean there is a problem with the diagnosis per se. Individual differences aside (e.g., if I had a prostate and a family history of aggressive prostate cancer and the BRCA gene, I would ask to have surgery even with a Gleason 6), no scrupulous surgeon will take out a prostate with a Gleason 6 ... and yet, it is happening. This is a different problem than the concern that PSA screening leads to biopsy leads to surgery. We need to incorporate the sources that deal with the whole issue. You, Doc, in particular are over focused on prioritizing the ignorant patient and the unscrupulous surgeon over the gazillions of men whose lives are saved by PSA screening. I do not believe you would operate that way in the real world, and I do not think that is how you would treat your own prostate. SandyGeorgia (Talk) 16:47, 6 March 2018 (UTC)

Catalona says the 2008 and 2012 USPSTF recommendations led to a decrease in PSA testing in the US. Who claims that USPSTF statement in 1996 has been harmful? QuackGuru (talk) 06:22, 6 March 2018 (UTC)

Both sources fail verification

"they still recommend against PSA screening for those who are 70 or older."

Ref says "The USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older."[7]

Supposedly per User:QuackGuru this failed verification and they removed the reference. I have restored it. Doc James (talk · contribs · email) 03:52, 3 March 2018 (UTC)

That does not verify the current claim. Why did you restore it? QuackGuru (talk) 15:18, 3 March 2018 (UTC)

Current text "Such screening is controversial and, in some people, may lead to unnecessary disruption and possibly harmful consequences."[8][not in citation given] Where does the source or any other source verify the claim? A source must also verify the weasel words "some people". QuackGuru (talk) 15:18, 3 March 2018 (UTC)

Current text "While USPSTF has reversed their complete opposition to PCa screening they still recommend against it for those who are 70 or older."[9][not in citation given] Where does the additional source[10][11] verify "USPSTF has reversed their complete opposition". QuackGuru (talk) 15:18, 3 March 2018 (UTC)

Any discussion of USPSTF should include the specific wording that their recommendations were flawed (d'oh-- that is why they had to back off). Because reliable sources say that, and because every urologist knows that. There is too much black-and-white here, and incorrect decisions in this area impact men's lives. Reputable urologists knew how to screen, how to detect, and how to treat in spite of the influence the USPSTF had on general physicians without specialist knowledge. You can find the wording in sources to make this article comprehensive-- it will not be a quick fix.

Anecdote. GP wasn't worried. We were lucky to have a friend who worked in urology, who said, get your prostate in here now. Urologists know. USPSTF unduly influenced entire organizations and general physicians with faulty analysis of data, and this only happened because of changes resulting from Obamacare. Let's not have wikipedia be on the wrong side of men dying, when reliable medical sources are available. You cannot write this article for a 12-year-old ... clarifying and expanding clauses will be needed. You do not like to write that way, Doc, but your black-and-white, clause-free sentences will not be comprehensive, accurate, or reflect all sources. Nuance and explanation are needed for every part of this topic. I suggest at least keeping an open mind to the fact that many more sources saying the same things will be the trend in 2018, because the uptick in non-organ-confined prostate cancer due to the USPSTF is on the demographic horizon. SandyGeorgia (Talk) 17:37, 3 March 2018 (UTC)

The exact quote is "The USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older." This is what they say. Whether or not they are write is a completely different argument. Doc James (talk · contribs · email) 12:21, 5 March 2018 (UTC)

The article goes on to say:

"The decision about whether to be screened for prostate cancer should be an individual one. Screening offers a small potential benefit of reducing the chance of dying of prostate cancer. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and impotence. The USPSTF recommends individualized decisionmaking about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision."

The text in bold supports "in some people, may lead to unnecessary disruption and possibly harmful consequences". Doc James (talk · contribs · email) 12:21, 5 March 2018 (UTC)

Current wording "Such screening is controversial and, in some people, may lead to unnecessary disruption and possibly harmful consequences.[89]"

The text contains the unsupported WP:WEASEL word "some" and the text in bold does not support "Such screening is controversial". Different sources make different claims. It will confuse our readers if sources are misplaced or do not verify claims.

Current wording "While USPSTF has reversed their complete opposition to PCa screening they still recommend against it for those who are 70 or older."

That quote does not verify "reversed their complete opposition". Verification has not been provided for "reversed their complete opposition" using the additional source. QuackGuru (talk) 23:42, 5 March 2018 (UTC)

And other sources explain that, in the US, at age 70, men still have 15 years of life expectancy, so PSA screening makes sense for healthy men. I have given you those sources, and it is possible to reflect both sides of the story. Prostate cancer is not binary-- every case and situation is different, and we should not be trying to write a black-and-white, one-size-fits-all article, when that is not what sources do, and that is not what practitioners do. There is an extreme over reliance on USPSTF here, to the exclusion of other sources. It would be more expedient to stop focusing on USTFPS and start writing from broader sources. For example (there are others): PMID 29406053 PMID 27995937

Could you also please stop using excess markup? SandyGeorgia (Talk) 00:51, 6 March 2018 (UTC)

Yes you really like a source written by the person who has patents on the test in question. We have lots of boarders sources beyond the USPSTF like the World Cancer Report, CDC, and NCI. Doc James (talk · contribs · email) 12:50, 6 March 2018 (UTC)

Both sentences now pass verification

"While USPSTF has reversed their complete opposition to PCa screening they still recommend against it for those who are 70 or older.[11]" This content passes verification without using the additional source that fails to verify "reversed their complete opposition".[12]

"Such screening is controversial[90] and, for many, may lead to unnecessary disruption and possibly harmful consequences.[91]" Unsupported weasel word was removed and each citation is placed where they verify each claim.[13] QuackGuru (talk) 00:07, 6 March 2018 (UTC)

Support

• Support, as proposer using the supported weasel word "many" and removing the additional citation that fails to verify "reversed their complete opposition".[14] QuackGuru (talk) 00:32, 6 March 2018 (UTC)

Discussion on both sentences

Premature to be jumping to RFC because you are both still over focusing on one source, one issue, and not even bringing in the broader issue-- no matter what this one flawed recommendation was, others do recommend screening for 70-year-old men. It is individual and about their overall state of health, family history, other factors. SandyGeorgia (Talk) 00:54, 6 March 2018 (UTC)

This is not about this particular recommendation. This is about verifiable content versus failed verification. I don't have a problem if the wording completely changes using a different source and so on. QuackGuru (talk) 01:57, 6 March 2018 (UTC)

Four RfCs at once is not appropriate.

It is also unclear what you are suggesting in this RfC.

Refs are supposed to go at the end of sentences or after punctuation, not in the middle of sentences. Doc James (talk · contribs · email) 12:48, 6 March 2018 (UTC)

I tried to discuss this previously. See Talk:Prostate cancer#Both sources fail verification.

Each citation is placed where they verify each individual claim. See WP:CITEFOOT and WP:INTEGRITY.

I clearly explained it in my edit summary on 16:22, 2 March 2018 before starting this RfC. I am unsure why the ref is being restored when it is not needed and does not verify the claim. I am proposing to remove the ref that was restored that does not verify "reversed their complete opposition".[15] QuackGuru (talk) 15:32, 6 March 2018 (UTC)

Proposal to include Canadian Urological Association recommendations in Prostate cancer#Screening section

Proposed wording: "The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making. The starting age for most people is at age 50 and age 45 among those at high risk." QuackGuru (talk) 07:24, 6 March 2018 (UTC) (Proposal has been changed. QuackGuru (talk) 16:26, 6 March 2018 (UTC))

References

Support

• Support, as proposer. Good information for those under 50 as well as over 50. QuackGuru (talk) 07:24, 6 March 2018 (UTC)

Oppose

• Oppose because CUA says no such thing. Doc James (talk · contribs · email) 13:06, 6 March 2018 (UTC)

Discussion on Canadian Urological Association recommendations

You are ignoring the bolded recommendation that they actually give which was already quoted above. There is also no reason to especially emphasize the Canadian guideline. This is exceptionally tendentious argumentation and weight. Jytdog (talk) 15:50, 6 March 2018 (UTC)

The CUA do say such things under the section Justification and they do say other things. The previous proposal and the adjusted proposal are both sourced. I am not tied to any specific wording. I removed the quote and adjusted this and other proposals. QuackGuru (talk) 16:26, 6 March 2018 (UTC)

See Talk:Prostate cancer#Discussion on replacing or keeping current wording for overall main discussion. I think that would clear up any confusion with this and subsequent proposals. QuackGuru (talk) 17:31, 7 March 2018 (UTC)

Proposal to include many doctors widely rejected prostate cancer screening in Prostate cancer#Screening section

Proposed wording: "As a result of the USPSTF's previous recommendations, many doctors widely rejected prostate cancer screening, which led to a return to more occurrences of high-grade and progressed prostate cancer being diagnosed." QuackGuru (talk) 07:24, 6 March 2018 (UTC)

References

Support

• Support, as proposer. We are documenting an ongoing controversy going back many years. This is relevant and on point. QuackGuru (talk) 07:24, 6 March 2018 (UTC)

Oppose

New cases and deaths from prostate cancer in the United States per 100,000 males between 1975 and 2014

• Oppose Guess why proportionally more high grade tumors occur with less screening? As less screening has occurred in the United States the number of not significant prostate cancers has doped in half. That means the denominator has gotten smaller. Lets say 10 high grade occur a year out of 100 = 10% high grade. Number of cases decreases to 50 with still 10 high grade that means we see 20% high grade. You add to this the fact that the author of the article in question holds a bunch of patents on the test in question / invented the test and will financially benefit from increased use. Doc James (talk · contribs · email) 13:01, 6 March 2018 (UTC)
• Oppose per Doc James. Additionally screening carries risks because while a high PSA does not mean the patient has cancer — it means additional tests are needed to make sure there is not a cancer. The only test that is valid per current evidence is biopsy, with the specificity and sensitivity of MRT and PET/CT being found in 2014 to be difficult to assess (http://www.sbu.se/en/publications/sbu-assesses/diagnostic-imaging-in-the-staging-of-prostate-cancer/ ). Biopsy is associated with bleeding and a has been implicated in a number of deaths. So you have 1. risks with biopsy, 2. risks with treatment for those who would never get sick, 3. the risks of provoking fear among those with high PSA but no cancer. In the grand scheme of things it isn't relevant that more high-grade cancers are found, when the absolute number goes down.

To present an analogous situation, if we started screening everyone for the common cold: We would find the number of hospitalizations for post-common cold pneumonia decreased relative to the number of cases of common cold. The statement can be made to sound alarmist, when in reality it doesn't mean anything. Carl Fredrik ^talk 16:14, 10 March 2018 (UTC)

Discussion on many doctors widely rejected prostate cancer screening

A 2018 review states, "In the aftermath of the USPSTF recommendations, the widespread rejection of screening by many primary care physicians has had far-reaching consequences, notably, a reversion to more PCa cases being high-grade and advanced at diagnosis."[16]

The above quote verifies the following proposal: "As a result of the USPSTF's previous recommendations, many doctors widely rejected prostate cancer screening, which led to a return to more occurrences of high-grade and progressed prostate cancer being diagnosed." QuackGuru (talk) 15:47, 6 March 2018 (UTC)

Different sources say similar things happened as a result of USPSTF's recommendations. For example, on another page it says "The PSA screening rates have dropped as a result of the 2012 USPSTF's position."[17] using another source. The text is being asserted as fact without including "studies indicate". There are no serious objections based on recent WP:MEDRS compliant sources. QuackGuru (talk) 17:12, 6 March 2018 (UTC)

A 2017 review states "Editorialising in The Journal of Urology, Samir Taneja, MD, wrote: “The mass confusion regarding interpretation of guidelines and application in practice is the result of a recommendation that is not particularly intuitive. How does one prevent prostate cancer death if one is not looking for prostate cancer?”87 In response to the October 2011 draft, the AUA responded by saying “the USPSTF—by disparaging the [PSA] test—is doing a great disservice to the men worldwide who may benefit from the PSA test”88…"[18] That's bad. I mean really bad. The review further states, "Moreover, clinicians and researchers have challenged the recommendation because the USPSTF excluded relevant data.[19] This Wikipedia article should not exclude relevant content from the lead or body. QuackGuru (talk) 02:54, 8 March 2018 (UTC)

A 2017 review found "The 2012 recommendation against routine PSA screening in all age groups has resulted in significant declines in PSA screening rates, with 23% to 45% of men being tested before the guideline statement compared to 17% to 35% after the guideline was published (table 1)."[20] QuackGuru (talk) 04:39, 8 March 2018 (UTC)

1st proposal to replace current wording in lead

Replace the following wording: "Prostate cancer screening is controversial. Prostate-specific antigen (PSA) testing increases cancer detection, but it is controversial regarding whether it improves outcomes. Informed decision making is recommended when it comes to screening among those 55 to 69 years old. Testing, if carried out, is more reasonable in those with a longer life expectancy."

References

Proposed wording: "The benefits and risks of prostate cancer screening are controversial. Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances. Prostate-specific antigen (PSA) testing has been questioned as a result of concerns regarding the risk of causing unneeded biopsies and overdiagnosis and overtreatment. Consensus has not been established regarding the usual screening regimen. The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making. The starting age for most people is at age 50 and age 45 among those at high risk.

"

References

Adjustments have initially been made. This proposal and others could change in the future. QuackGuru (talk) 17:22, 6 March 2018 (UTC)

Support

• Support as 1st choice, as proposer. This proposal provides much more useful content than the current wording. QuackGuru (talk) 07:24, 6 March 2018 (UTC)

Oppose

• Oppose This is language often used to promote something "Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances". "May" in medicine equals "may not" just as easily.

Prostate cancer is current controversial and thus "remain" is not needed.

This "Consensus has not been established regarding the usual screening regimen" is belongs in the body. There is not even consensus regarding if screening should be offered generally at all.

This is simple wrong "The Canadian Urological Association in 2017 recommends obtaining screening at age 50"

This is what they actually say "The CUA suggests offering PSA screening to men with a life expectancy greater than 10 years. The decision of whether or not to pursue PSA screening should be based on shared decision-making after the potential benefits and harms associated with screening have been discussed."

"Offering screening" DOES NOT EQUAL "recommends obtaining screening"

Doc James (talk · contribs · email) 13:02, 6 March 2018 (UTC)

The CUA do say such things under the section Justification, but I rewording part of the proposal to move things forward. I also changed "remain" to "are". If you think the proposal could be more concise or if you have a better suggestion you can make a 3rd proposal or you can provide more feedback. The current wording in the lead provides very little information. QuackGuru (talk) 16:26, 6 March 2018 (UTC)

2nd proposal to replace current wording in lead

Proposed wording: "The benefits and risks of prostate cancer screening are controversial. Prostate-specific antigen (PSA) testing has been questioned as a result of concerns regarding the risk of causing unneeded biopsies and overdiagnosis and overtreatment. The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making. The starting age for most people is at age 50 and age 45 among those at high risk.

"

References

I have trimmed this proposal and made it more concise than the original proposal. QuackGuru (talk) 01:46, 7 March 2018 (UTC)

Support

• Support as 2nd choice, as proposer. This proposal is more concise than the original. The following two sentences have been removed from this proposal: "Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances.[2] Consensus has not been established regarding the usual screening regimen.[1]" Everything else is the same as the original. QuackGuru (talk) 01:47, 7 March 2018 (UTC)

Oppose

• Oppose Has the same problems as above. Doc James (talk · contribs · email) 13:15, 6 March 2018 (UTC)
  • Please be aware I reworded the proposal and it is much shorter than the previous one. What do you think about the new proposal? QuackGuru (talk) 16:25, 7 March 2018 (UTC)

3rd proposal to replace current wording in lead

[Please place your proposal here.]

Discussion on replacing or keeping current wording

The current wording suffers from citation bloat (also known as citation overkill). It also fails to provide highly useful information. For example, the lead provides absolutely no information regarding prostate cancer screening for those under age 50. Just saying it is controversial without any explanation does not provide any benefit for our readers. QuackGuru (talk) 07:24, 6 March 2018 (UTC)

This is the same thing you wrote above. These tactics are not tolerable, Quackguru. Jytdog (talk) 15:59, 6 March 2018 (UTC)

I removed the quote and adjusted the proposals. QuackGuru (talk) 16:26, 6 March 2018 (UTC)

There are issues with the current citations. For example, see the current wording "Prostate-specific antigen (PSA) testing increases cancer detection, but it is controversial regarding whether it improves outcomes.[10][11][12]" Does any source verify "...it is controversial regarding whether it improves outcomes."? Let's review. Source says "Randomized trials have yielded conflicting results.[16-18] Systematic literature reviews and meta-analyses have reported no clear evidence that screening for prostate cancer decreases the risk of death from prostate cancer, or that the benefits outweigh the harms of screening."[21] Source says "Prostate cancer (PCa) screening is controversial."[22] Source says "Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community."[23] I would change it to "but it is unclear regarding whether it improves outcomes.[10]" I would also remove the other two citations ([11][12]). See WP:V policy. QuackGuru (talk) 04:41, 7 March 2018 (UTC)

I did a word search for "expectancy" to try to verify the following sentence: "Testing, if carried out, is more reasonable in those with a longer life expectancy."

See "Recently, however, these figures have been declining with decreased rates in routine screening. In light of factors such as the growing Australian population and increasing life expectancy, the Australian Institute of Health and Welfare predicts that this number will continue to rise to approximately 25,000 and 31,000 in 2020"[24] Does that verify the claim? No. See "Royal College of Pathology Australia (2016) Recommended In men whose life expectancy is > 7 y Both a PSA test and a DRE from the age of 40 y on an annual basis"[25] Does that verify the claim? No. See "The American Urological Association (AUA) recommends against PCa screening in men aged < 40 years and in men aged ≥ 70 years with a life expectancy of < 10 years." Does that verify the claim? No. See "Men who have a life expectancy of < 7 years should be informed that screening for PCa is not beneficial and has harms because many of the benefits from screening may take > 10 years to ensue."[26] Does that verify the claim? No.

What do others think about this? Can anyone else verify the claim for the following sentence? "Testing, if carried out, is more reasonable in those with a longer life expectancy." If the content fails verification it should be removed or rewritten. QuackGuru (talk) 16:42, 9 March 2018 (UTC)

• What is the difference between highly useful content and okay content?

• Compare side by side "Prostate cancer screening is controversial.[10][3]" in the lead versus "The benefits and risks of prostate cancer screening are controversial.[1] Just saying it is controversial without expanding why it is controversial is uninformative and unhelpful.

• Part of current wording in the lead: "Informed decision making is recommended when it comes to screening among those 55 to 69 years old.[13] Testing, if carried out, is more reasonable in those with a longer life expectancy.[14] This content states from 55 to 69 but does not include any suggestion for those under 50. Stating that those with a longer life expectancy for testing is way too vague. Therefore, it really does not tell anyone anything useful.

• Part of proposed wording for the lead: "The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making.[4] The starting age for most people is at age 50 and age 45 among those at high risk.[4]" This content has specific information for those over 50 and has specific information for those under 50. It also explains screening can be offered to those who are expected to live more than 10 years rather than the current vague wording stating ...those with a longer life expectancy. There is a clear difference between quality content and not very helpful content. See Talk:Prostate cancer#2018 position for previous talk page discussion and see under Dangerous Wikipedia prostate suite of articles for continuing discussion on this topic. QuackGuru (talk) 16:09, 7 March 2018 (UTC)

• User: QuackGuru please pull these RfCs. Thanks. Jytdog (talk) 22:36, 9 March 2018 (UTC)

Comments on the whole lot of RFCs

I am not participating in the massive filling up of this page with RFCs. I consider all efforts to work on only the lead a mistake in editing that should be reserved for novice editors. I also consider that the various "sides" in this debate are simply refusing to hear the others.

Leads are summaries, and the body of the article is a mess. Cleaning up the body will fix the lead. You agree on content in the body-- later you summarize that to the lead. Experienced editors should stop this thinking that they can only clean up leads, and ignore bodies of articles.

Further, there is original research throughout these talk page discussions -- doctors and lay persons arguing their case without consulting sources. You don't get to just leave out a whole ton of reliable sources because you don't personally agree with them. Treating prostate cancer is particularly difficult, because no two cases are alike, and yet we have people here arguing from the naive (a position of not having or treating cancer, and yet ignoring reliable sources from those who do).

Furthermore, jumping to RFCs when valid discussion is happening is not helpful. And RFCs are likely to just bring in people who have no knowledge of medical issues or medical editing.

The problem in this entire suite of articles can be summarized as one POV that has been given preference over multiple other reliable sources. That is slowly changing. Start listening to each other and using all sources-- not just government sources with one POV. Clean up the POV in the article, the lead will fix itself. Canada, by the way, is by no means the only area left out of this article. SandyGeorgia (Talk) 17:00, 6 March 2018 (UTC)

PS, I am off now to the hospital for an overnighter. That means, if I am able to edit, it will be from an iPad, with resulting typos, edit summaries, etc. Sorry in advance. I catch up as I am able from a real computer. SandyGeorgia (Talk) 17:23, 6 March 2018 (UTC)

Agree these are premature. It is unfortunate the discussion of these articles has become so combative. As we have seen elsewhere, this will slow improvement, by keeping others from contributing. Johnbod (talk) 18:18, 8 March 2018 (UTC)

(summoned here by the RFC bot) I support the idea that the work on the lead must be mostly about the improvements it adequately covers the article. That the lead requires a lot of footnotes is a big bright red flag the article body is inadequate. Staszek Lem (talk) 18:47, 8 March 2018 (UTC)