Talk:Prostate cancer screening

Not yet??

Quoting the article:

"Randomized controlled trials have not yet shown that early detection of prostate cancer with PSA testing does more harm than good, but many feel that the 4% annual decline in prostate cancer mortality rate in the United States over the past decade must be attributable to PSA screening, though improvements in treatment, including more widespread use of androgen deprivation for advanced cancer, may explain some of this trend. "

IMO there are problems with this sentence.

-- It is too long; a full stop after "than good" would be appropriate I think. (Perhaps also one after "improvements in treatment".)

-- The part about more harm than good is without context. There is no prior mention of the idea that early detection may "do harm" and no explanation of why it might.

-- The word "yet" implies a belief that it will eventually be shown that 'early detection does harm', a highly speculative notion IMO.

I realize some of these points are likely covered in other articles but I think this article should be better able to stand on its own. Wanderer57 (talk) 20:35, 26 August 2008 (UTC)

Medical malpractice and PSA

Here's a good free link to the Merenstein article on how doctors can lose a medical malpractice case for not giving PSA tests:

JAMA. 7 January 2004;291:15-16. A Piece of My Mind: Winners and Losers, Daniel Merenstein.

--Nbauman (talk) 18:38, 23 October 2009 (UTC)

OMG that is ridiculous. The poor man. But then I guess that is what happens when you leave these things to juries to decide. The deceased also deserves some sympathy but it is not all clear that his outcome would have been much changed by an earlier PSA test. Sadly surving life is a matter of negotiating a mass of statistical probability hurdles. Crossing the road has risks and benefits. The exceptions are always exceptions and one should not be led into thinking that the exceptions make the rule. As I understand American urological professional guidance, the doctor did what his profession guides him to do. This is similar to guidance in the UK http://www.patient.co.uk/pdf/pilsL493.pdf which is there to enable the patient to make the decision for himself. They don't insist on getting the patient to sign that they have received the advice, but even in this case it would not have helped the poor Dr. given that 4 other Drs. were prepared to testify that they wouldn't have even give the patient the choice of having the test. Amazing, but sad and instructive.--Hauskalainen (talk) 01:11, 24 October 2009 (UTC)

paragraph about medications that lower PSA levels

Created separate paragraph about medications that lower PSA levels, adding info that finasteride cuts levels in half) (both doses) and mention the clinicial implications (must adjust reference ranges and velocity of change calculations accordingly) Leave brand name marketing information to linked Finasteride and Duasteride articles.

If someone has time to update more, suggested range tops out at 2.0 instead of 4.0 in patients taking finasteride, rate calculations go to a change of .3 per year instead of .7.

Ocdcntx (talk) 15:04, 7 March 2010 (UTC)

Is cost-benefit analysis to date missing the point?

"1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent just one death from prostate cancer.[5]" (article)

At a glance, it appears that all 48 men with prostate cancer would need aggressive treatment to prevent one death. This overlooks that many such patients will be offered, and choose, active surveillance and proven prevention methods (see next discussion section).

The with highest scores, may indeed be recommended to, and receive, more invasive intervention -- and should be. But the benefits for the group with highest-risk cancers in preventing death and disability are highest. More of this highest-risk cancer group will choose aggressive intervention precisely because they quite rightly conclude that they likely have a curable prostate cancer that is of concern for metastasis if treatment is delayed.

If active surveillance plus proven risk-reduction methods are suggested to many of the lower-risk patients among the 48 identified cancer cases, then many of them will never be subjected to invasive interventional methods.

The usual cost-benefit analysis seems to be based on the idea that the costs side for all 48 men includes intervention more invasive than active surveillance and prevention methods, which may not be the case.

Ocdcntx (talk) 16:20, 7 March 2010 (UTC)

Some benefits of PSA testing have been overlooked.

Peace-of-mind and patient-education benefits of PSA testing for the men with low scores may also have been given short shrift. In the first European study cited by the article, most of the 1410 men tested may worry less after learning they do not have prostate cancer. At the same time, the testing provides their physicians an opportunity to provide valuable education about BPH progression, and to counsel them about available prevention measures. These benefits to the men who do not have cancer identified by PSA testing have been overlooked.

The costs to men who learn through PSA testing that they have prostate cancer may have also been overstated or exaggerated. Such men may be offered, or elect, active surveillance (formerly "watchful waiting") plus proven prevention methods. This will allow many of them to avoid unneeded treatment while those who do need invasive interventional treatment secure it when events develop to show that it is needed. An accurate cost-benefit analysis must figure the costs of invasive testing of the smaller group that actually selects invasive intervention only. Meaningful weighing of the costs against the benefits requires not exaggerating the costs.

Ocdcntx (talk) 16:27, 7 March 2010 (UTC)

Effective, non-invasive risk-reduction measures are available for most men revealed by routine PSA screening to have prostate cancer.

These methods are available to all men, even those who have not yet developed prostate cancer, but are especially salient to those in whom prostate cancer is identified (now, often via a PSA screening):

1. Regular use of Finasteride has been shown to reduce the rate of invasive prostate cancer (and all cancers) by 30% in well-conducted trials.

2. Learning one is at higher prostate cancer risk may provide additional reason to correct use/abuse of anabolic steroids, testosterone, or androgenic precursors, or to lower high BMI, and to quit smoking.

3. A study by Ornish et al. found that prostate cancer markers were affected by a low-fat diet that included small amounts of fish, combined with exercise, stress-reduction, and counseling. Learning that one's PSA level is in a range that corresponds to higher risks may increase motivation to pursue one or more of these interventions, which may result in improved health and lower all-cause mortality and morbidity.

4. NSAID use may reduce metastisis.

5. Men revealed by a screening test to have low-grade prostate cancer, or simply an elevated PSA, may also be counseled about the effective long-term management of BPH, including drugs such as finasteride and dutasteride which may stop the progress of overgrowth before symptoms emerge that may later affect quality of life, as well as the other lifestyle changes mentioned above.

Ocdcntx (talk) 16:32, 7 March 2010 (UTC)

Overlooked patient counseling opportunities, not cancer screening, must take any blame for over-treatment in connection with PSA screening

If only the higher-risk of the 48 are treated with aggressive intervention, the rate of lives saved per intervention will be much higher.

The missed opportunities to counsel men with higher PSA test results on non-invasive active surveillance and proven risk-reduction measures is to be faulted -- not administration of the PSA and other screening measures such as DRE. Such screening provides a teachable moment about the advisability of measures which reduce risks of both prostate cancer and advanced BPH.

As an example of overlooked medical counseling, how many men with high PSA levels have been advised that extreme PSA can eventually result in inability to urinate and, if unattended to, even kidney failure?

Ocdcntx (talk) 16:47, 7 March 2010 (UTC)

Free online screening algorithm from University of Texas

http://deb.uthscsa.edu/URORiskCalc/Pages/calcs.jsp

Calculates risk given age, race, PSA, DRE, family history, prior biopsy history, BMI info (ht & wt)

Non-BMI version is available via a link on the page. —Preceding unsigned comment added by Ocdcntx (talk • contribs) 18:16, 7 March 2010 (UTC)

PCA3 another marker

The University of Texas cite also calculates results from PCA3 if available.

"Prostate cancer antigen 3 (PCA3, also referred to as DD3) is a gene which has noncoding messenger RNA that is overexpressed in prostate cancer.[1][2] This messenger RNA is useful as a tumor marker.[3]"

Not sure if test is available in the U.S.

Ocdcntx (talk) 18:19, 7 March 2010 (UTC)

AMACR is more sensitive and specific than the PSA test

AMACR (a newer test that is more sensitive than the PSA test for determining prostate cancer) —Preceding unsigned comment added by Ocdcntx (talk • contribs) 14:55, 10 March 2010 (UTC)

AMACR has 2003 and 2005 sources but does not suggest that the test has been approved. - Rod57 (talk) 09:44, 30 June 2012 (UTC)

Obesity in screening prostate cancer risks -- Hazard Ratio 2.66 compared with healthy-weight men

"... Compared with men of a healthy weight (BMI <25 kg/m(2)) at baseline, overweight men and obese men had a significantly higher risk of prostate cancer mortality (proportional hazard ratio [HR] 1.47 [95% CI 1.16-1.88] for overweight men and 2.66 [1.62-4.39] for obese men; p(trend)<0.0001). ..."

PMID 18835745

"... BMI was an independent predictor of higher Gleason grade cancer (P <.001) and was associated with a higher risk of biochemical recurrence (P =.027). ...

PMID 14691120

"... BMI was positively associated with prostate cancer mortality—the higher the BMI, the greater the risk of death. Men with a BMI of 35 or greater had more than two times the risk of dying than normal-weight men.

In addition, weight gain during adulthood also significantly raised the mortality risk from prostate cancer. As with BMI, the risk of death increased as the amount of weight gain increased.

The study sheds light on yet another potential benefit of maintaining a healthy weight, especially since prostate cancer is a common cancer among American men.

Article Information

Wright M, Chang S, Schatzkin A, et al. Prospective Study of Adiposity and Weight Change in Relation to Prostate Cancer Incidence and Mortality. Cancer. 2007;109(4):675–684."

http://win.niddk.nih.gov/notes/summer07/winnotes_summer07.htm#r2

"... Whether BMI is associated with prostate cancer-specific mortality (PCSM) was investigated in a large randomized trial of men treated with RT and androgen deprivation therapy (ADT) for locally advanced prostate cancer. ... In multivariate analyses, greater BMI was significantly associated with higher PCSM (for BMI ≥25 to <30, hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.02–2.27, P = .04; for BMI ≥30, HR 1.64, 95% CI, 1.01–2.66, P = .04). ..."

http://deepblue.lib.umich.edu/handle/2027.42/57506

"... [F]or fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and alpha-linolenic acid were associated with a statistically significant increased risk.

PMID 17450530 —Preceding unsigned comment added by Ocdcntx (talk • contribs) 15:04, 10 March 2010 (UTC)

issues with this article

I have made a few changes here today - the lead section is really quite POV. I think someone has mistaken generalised prostate cancer screening with a specific type of prostate cancer screening - i.e. the PSA test. Don't confuse the two - just because PSA has not proven successful it doesn't mean prostate cancer screening per se is potentially detrimental. This article still needs a lot of work - what about screening methods other than PSA and DRE? Cheers, --Amaher (talk) 02:15, 16 March 2010 (UTC)

BPH

Benign prostatic hyperplasia (BPH) also known as benign prostatic hypertrophy (technically a misnomer),recommend changing to correct term hyperlasia from hypertrophy. (reference from hotlink is correct). —Preceding unsigned comment added by 97.126.243.188 (talk) 22:26, 26 May 2010 (UTC)

Clinical practice guidelines section is huge

The 'Clinical practice guidelines' section is large and repetative eg it discusses the ACS guidelines twice at length. Perhaps the blockquote should be deleted ? - Rod57 (talk) 02:20, 3 November 2011 (UTC)

"Hyperbole?"

This article needs a lot of work. My recent edit was completely reverted without any explanation - other than calling it "hyperbole" in the edit summary. 1st - I edited: "This recommendation has been criticized by many prostate cancer experts for a number of reasons, most important among which is its over-reliance on findings from the deeply flawed U.S. Prostate, Lung, Colon, and Ovarian screening trial to make it more neutral. The "deeply flawed" is not in the cited source - which is the original paper on the trial. Clearly inappropriate.

I also put in half a sentence on why the test is considered controversial following: "The test is controversial". The reverter says the material I added is already in the article (yes but at the very bottom of an overly long article), and that the material is hyperbole (complete nonsense - if the test is controversial, it should be explained why).

The material I added is generally supported by the new official recommendation of the U.S. Preventive Services Task Force. See e.g. Prostate Cancer Test Gets a Failing Grade. This material needs to be included, not trashed with completely unsourced nonsense like "deeply flawed."

BTW - before you ask me to comment on the talk page, it would be appropriate to explain yourself on the talk page first.

Smallbones (talk) 12:20, 22 May 2012 (UTC)

It looks to me that there may be misunderstanding in this little discussion (here and in edit summaries). Perhaps both editors, Smallbones & UncleBubba, will take a second look.

Smallbones: I may be wrong but I don't think the mention of hyperbole referred to your edit of the para starting "Prostate test screening is controversial ........."

The sentence you modified,

FROM "Prostate test screening is controversial."

TO "Prostate test screening is controversial because of it low effectiveness in reducing deaths, the side effects resulting from over-diagnosis from the tests, including impotence, incontinence, and bowel disorders, and its high costs.",

seems to me to pack too much information into one sentence. However I sympathize with your desire to have a succinct statement on the controversy early in the article. Wanderer57 (talk) 18:37, 22 May 2012 (UTC)

Feel free to re-write, but, correct me if I'm wrong, those are the reasons that screening is controversial. If so, they need to be included right near the top - preferably right after the word "controversial." The new material from the U.S. Preventive Services Task Force (link above) also needs to be included. The official position needs to be clearly spelled out before it is criticized, and that should not be controversial. Smallbones (talk) 22:02, 22 May 2012 (UTC)

While it's apparent your edit was well-intended, inserting terms like impotence, incontinence, bowel disorders, etc. into the lede of the article looks too sensational.

The source is an op-ed piece discussing a current controversy, and there is disagreement within the medical community regarding the efficacy and wisdom of PSA screening. I wouldn't oppose a more balanced and neutral-sounding summation here, but in-depth discussion of the controversy should be placed in its own section within the body of the article, not in the lede.

My overriding concern is that a great many people use Wikipedia to gather information, and some of this information will be used to make life-affecting choices. As such, we editors have a responsibility to present information accurately, clearly, and coherently, in a balanced and impartial manner.

I did not intend to step on your toes, but I feel we need some consensus before this text is added to the article. As such, I'm removing it. I hope you will, in the spirit of WP:BRD discuss it with me (and any other interested persons) here before taking further action.

Thank you. — UncleBubba ^{( T @ C )} 04:21, 23 May 2012 (UTC)

The material I've just put in is an explanation of the official US government position - it needs to be near the top - it is the predominate scientific position - both in the US and in Europe. Using words like "impotence" and "incontinence" may be a bit frightening - but that is what the problem with the test is all about. Using the word "cancer" is also frightening - but we can't discuss the material without these words. Smallbones (talk) 00:44, 29 May 2012 (UTC)

--- I think it would be better for this article if you did not insist quite so vigorously on your point of view. As suggested above, discussion is called for.

Why do I say this?

1. What we now have is a lead section which is confusing because of its on-the-one-hand, on-the-other-hand nature. Perhaps not confusing to a person well familiar with the whole controversy but certainly so to most laymen.
2. Your reasoning relies heavily on the official US government position. Bear in mind that Wikipedia is intended for an international audience. The information I have heard from non-US sources is that the US anti-testing approach is conditioned by the US approach to aggressive treatment of prostate cancers when they are detected, and that a more measured approach to treatment would have resulted in less of the seriously negative consequences you warn about.

My point in mentioning these issues is not to say that you are wrong and somebody else is right. It is to try to advance the idea that prior discussion might be a more fruitful approach than unilateral edits. Wanderer57 (talk) 05:03, 29 May 2012 (UTC)

Please clean up the rest of the article before you complain that the predominant scientific position is out of place. Have you noticed that most material is repeated twice (before my edits), but that the predominant scientific position is mentioned only in a few phrases at the bottom of the article? Also the "unilateral edits" that I've seen are just reversions of what I've written. The anti-testing position is similar in Europe as well as in America. Please don't try to minimize the lack of balance in the article before I edited it - there was almost no mention of the predominant scientific position, and it needs to be stated up front. Smallbones (talk) 05:30, 29 May 2012 (UTC)

Thank you. I am not going to review the history of this article to form an opinion whether it was better or worse before your edits. It may well have been improved by them.

My comments above were about the state of the article at the time of the comments.

I will take a look at the article as it now stands after your recent edits. Wanderer57 (talk) 15:15, 29 May 2012 (UTC)

specialty society guidelines

the lead paragraph now reads like a list of the different guidelines, rather than a summary of the subject, but my attempt to collapse the other guidelines to avoid this was not well-received. suggestions? -- [ UseTheCommandLine ~/talk ] # _ 18:33, 5 April 2013 (UTC)

Further, more than half of the lead paragraph is taken up by a discussion not of prostate cancer screening per se, but PSA screening in particular, which is inappropriate. -- [ UseTheCommandLine ~/talk ] # _ 18:34, 5 April 2013 (UTC)

First of all, prostate cancer screening is about PSA screening -- DRE-based screening is virtually (not yet entirely) irrelevant in 2013. The simple fact is that the USPSTF is not the definitive guideline. It is not better, not more reliable, and no more evidence based than the others. There is no justification for giving it more attention. You obviously feel that specialists are less trustworthy that primary care providers on this question, but that it just your opinion. Personally, I think it would be much better to simply present the evidence for and against screening and save the guidelines for the end. As I keep saying, this is a two-sided debate, and both sides must be given equal voice. — Preceding unsigned comment added by Drcoop (talk • contribs) 18:42, 5 April 2013 (UTC)

Please don't make assertions, assumptions, or accusations about what I think or feel, that seems inconsistent with assuming good faith. -- [ UseTheCommandLine ~/talk ] # _ 18:52, 5 April 2013 (UTC)

With all due respect, Drcoop, DRE-based screening is certainly not irrelevant, virtually or otherwise. Any changes to the article in this regard will require some significant sourcing. WP really isn't a forum for debate, nor is it an outlet for current event news. Your assertion that you know that another editor "obviously" feels a certain way is getting dangerously close to a personal attack. Let's discuss the article, not the editors--we're all on the same team here. — UncleBubba ^{( T @ C )} 21:08, 5 April 2013 (UTC)

Never suggested DRE should be removed from the article. Point was in response to the suggestion that too much time was being spent on PSA. I'm really not trying to debate, but these articles--both this one and the prostate cancer one--present the position that the answer on PSA screening is known and settled, when in fact it is not. I have met a great deal of resistance over the past couple of days trying to make this point clear, and am frustrated. Not intending anything personal.152.132.10.134 (talk) 21:45, 5 April 2013 (UTC)

I think you may be misinterpreting things a bit. These articles obviously change from day to day and week to week as new evidence comes in. However, the practice as is common in biomedical literature of saying explicitly that "more research is clearly needed" or the like, is not a norm here. We summarize what is the best available, reliable evidence here, without doing our own original research. WP is not a forum for cutting edge research.

The assertion that "There is no justification for giving [the USPSTF guidelines] more attention." also seems difficult to square with the fact that these guidelines help determine what bodies like CMS and the VA are willing to pay for, I suspect moreso than the opinions of specialty societies or the AMA (but that's maybe getting a little too WP:NOTFORUMish, i digress.) It also prompts me to wonder a bit about what the standard of care is in other countries, since this all seems to inordinately focus on the US.

And your assertion that both (or all) sides must get equal treatment is plainly incompatible with WP's norms and policies, specifically the policy on undue weight. My reading of that policy would seem to suggest that the USPSTF guidelines should have an explicit mention in the lead para, and further that naming the other organizations who have released guidelines subsequently that challenge the USPSTF's in some way gives those guidelines undue weight. Certainly they should be mentioned in the body of the article, specifically in the context of secondary, RS coverage of them, but to have them sticking out in the lead para like they are right now seems undue. I think the substance of my initial attempt at compromise, corraling them as references for a statement about "Other guidelines" is reasonable, but I am open to other suggestions. -- [ UseTheCommandLine ~/talk ] # _ 22:39, 5 April 2013 (UTC)

Information about racial disparities in incidence and outcomes

The article could use a section on the documented disparities in both incidence of (aggressive?) prostate cancer and prevalence of poor outcomes in men with African genetic background. I'm not qualified! — Preceding unsigned comment added by 66.92.161.127 (talk) 01:24, 21 June 2013 (UTC)

Self-citation COI

I have a self-citation COI with RTI International, a non-profit contract research organization. They published a study in a peer reviewed journal about how many men were planning on getting prostate exams, despite advice not to. I was thinking this may be a useful addition to this article after the paragraph starting with "The United States Preventive Services Task Force (USPSTF) recommended against PSA screening in healthy men finding that the potential risks outweigh the potential benefits..." as the study was done in the context of the controversy related to this recommendation by the USPSTF.

I would propose something like:

In July 2013, scientists from RTI International conducted an online survey of 1089 men that were 40-74 years old and had no history of prostate cancer. It found that 62% agreed with the recommendations by the United States Preventive Services Task Force to avoid prostate test, but only 13 percent planned to follow the recommendation and stop getting prostate exams. The study concluded that consumers were "favorably disposed to PSA testing, despite new evidence suggesting the that the harms outweigh the benefits."

References

• Prostate-Specific Antigen Testing Men's Responses to 2012 Recommendation Against Screening (PDF), American Journal of Preventative Medicine, July 9, 2013, retrieved August 15, 2013 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Dotinga, Randy (July 9, 2013). "Many Men Plan to Ignore PSA Test Guideline: Survey". US News.

Thoughts? CorporateM (Talk) 19:01, 15 August 2013 (UTC)

Primary source? In the lead para? in conjunction with about as strong a secondary source as you can get? how about no? Or maybe you want to ask over at WT:MED. -- [ UseTheCommandLine ~/talk ]# ▄ 05:22, 16 August 2013 (UTC)

Oops, I hadn't read through the whole section, but now see it should go at the bottom of that section to be chronological. There are other potential secondary sources, though not enough to call it a major media event or anything. I would rather not raise it to the Wikiproject. If editors here don't think the study should be added, that's fine. Seemed like it would be useful is all. Cheers. CorporateM (Talk) 22:37, 17 August 2013 (UTC)

That is not an appropriate secondary source for anything that could be construed as a medical claim, whether the claim is about practice patterns or efficacy or whatever. Are you familiar with WP:MEDRS? -- [ UseTheCommandLine ~/talk ]# ▄ 22:56, 17 August 2013 (UTC)

I am familiar with it, but not extensively, so I humbly accept your judgement on the issue. From what I've read, it seems we would prefer peer-reviewed journals that critically examine and summarize the available research as secondary sources. Since this study was just published in July, I would expect it to take some time before a source like that emerges. I have seen us use much weaker sources for medical claims (studies with only 80 participants, etc.), but such guidelines are complicated, which is why it's better for an editor with a COI to point out things that may be helpful, rather than edit, since I may construe the rules in a self-serving manner mistakenly. CorporateM (Talk) 23:56, 17 August 2013 (UTC)

The fact that lots of articles are poorly referenced and not in compliance with the MEDRS guidelines is a point of never-ending shame (I kid, but only slightly). -- [ UseTheCommandLine ~/talk ]# ▄ 00:07, 18 August 2013 (UTC)

• You are asking to add the information to the 'Controversy about Screening' section (not the lead paragraph). The medical claim in your request is "evidence suggesting the that the harms outweigh the benefits". Regarding, 3. people agreeing/disagreeing with 2. task force recommendation about 1. prostate cancer screening is two steps removed from the main topic, prostate cancer screening. As for 4. scientists from RTI International reporting 3. people agreeing/disagreeing with 2. task force recommendation about 1. prostate cancer screening is three steps removed from the main topic. Also, 5. RTI International opinion about 4. scientists from RTI International survey of 3. people agreeing/disagreeing with 2. task force recommendation about 1. prostate cancer screening is four steps removed from the main topic and is an opinion (study concluded that consumers were "favorably" to testing). The whole Controversy about Screening section does not make sense since it lacks structure/flow. The sub section is problematic in that it seems to be about "reaction", not "controversy": There have been a variety of reactions to the cost and long-term effect of screening patients for prostate cancer. That probably is not a sufficient description. We might be able to work in the two sources you list into the subsection, but cannot even consider how to do that without first rewriting the 'Controversy about Screening' section using the information already in the article so that the section makes sense. -- Jreferee (talk) 01:53, 18 August 2013 (UTC)

• I was asked for my opinion on this.

• We can use primary sources in medical articles, carefully.
• The proposed edit does not cover safety, efficacy or biological claims, just preliminary information about attitude, so this seems alright to me to include based on one good primary source, provided it's made clear that it is only one study, and the size of the study.
• Only cite the journal article, not the US News item
• As the information was collected November-December 2011, it's already a little old - for an attitude survey whose results will be affected by ongoing publicity and primary practitioner (GP) behaviour, so
• Do mention the period over which the data was collected.
• Don't mention RTI, it's not sufficiently relevant.
• Do mention the 33% undecided so you're reporting a clear picture of the results.
• Don't mention the authors' conclusions, just the results. Leave drawing conclusions to independent expert reviewers.
• It could be more concise.

If there is consensus for inclusion, may I suggest something along these lines?

In a November-December 2011 internet survey of 1089 men with no history of prostate cancer who had reviewed the USPSTF recommendation, although 62% agreed with the recommendation, only 13% intended to follow it and avoid the PSA test, while 54% intended to disregard it and planned to have a PSA test (the remainder were undecided).

Anthonyhcole (talk · contribs · email) 06:48, 18 August 2013 (UTC)

Milking out the Screening Pro's and Con's

The entire article seems to go on an on and on ad nauseam on the pro's and con's of screening. There is a paragraph 'Controversy about screening'. Then the next paragraph, 'Clinical practice guidelines', again picks up about those pro's and con's. Meanwhile I couldn't find anything in here (not even a ref.) to PSA tests that are conducted when e.g. as part of a CT scan lung noduli are found, which lead to a blood test, part of which is a PSA test (becuase of the noduli, i.e. not a 'screening' test in that sense: there was a cause to test for PSA. Sorry for not using standard med. terms, just a layman with a particular interest. — Preceding unsigned comment added by 82.95.236.142 (talk) 00:25, 22 March 2014 (UTC)

Redundancy, long-term projections based on ERSPC data.

Redundancy: Sections "Clinical practice guidelines" and "Research" (italic) contain quasi identical paragraphs, with only seven words difference (underlined):

• In the European Randomized Study of Screening for Prostate Cancer (ERSPC) initiated in the early 1990s, the intention was to evaluate the effect of screening with prostate-specific antigen (PSA) testing on death rates from prostate cancer. The trial involved 182,000 men between the ages of 50 and 74 years in seven European countries randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. During a median follow-up of almost 9 years, the cumulative detected incidence of prostate cancer was 820 per 10,000 in the screening group and 480 per 10,000 in the control group. Deaths from these cancers in this time was much lower. There were 214 prostate cancer deaths in the screening group and 326 in the control group, a difference of 7.1 men per 10,000 in the tested group compared to the control. The researchers concluded that PSA-based screening did reduce the rate of death from prostate cancer by 20%, but that this was associated with a high risk of overdiagnosis, which means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent just one death from prostate cancer within 9 years.

• In the European Randomized Study of Screening for Prostate Cancer (ERSPC) study initiated in the early 1990s, the intention was to evaluate the effect of screening with prostate-specific antigen (PSA) testing on death rates from prostate cancer. The trial involved 182,000 men between the ages of 50 and 74 years in seven European countries randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. During a median follow-up of almost 9 years, the cumulative detected incidence of prostate cancer was 820 per 10,000 in the screening group and 480 per 10,000 in the control group. Deaths from these cancers in this time was much lower. There were 214 prostate cancer deaths in the screening group and 326 in the control group, a difference of 7.1 men per 10,000 in the tested group compared to the control. The researchers concluded that PSA-based screening did reduce the rate of death from prostate cancer by 20% but that this was associated with a high risk of overdiagnosis. Statistically, it means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent just one death from prostate cancer.

Long-term projections based on ERSPC data:

• One recent analysis of the ERSPC data suggested that projecting over a 25-year time horizon, which is more appropriate for a man in his 50s than the 9 years reported to date from the trial, the number needed to screen falls to 186-220, and the number needed to treat to prevent a death falls to between 2 and 5 men.

Some important information is omitted here, namely that this is a projection for the US situation. Their projection for Europe (which the reader will assume since it is an analysis of a European study) is: 262 men need to be screened and 9 additional men need to be treated to prevent one prostate cancer death. Prevalence (talk) 15:43, 28 January 2016 (UTC)

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)