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Early Detection and Diagnosis

There is a large industry built up around testing for prostate cancer and the article as it was written seemed biased towards testing. I have attempted to remove some of this bias and balance it with the American Cancer Society's position statement. Further, new EN2 testing may greatly alter how frequently expensive procedures such as a biopsy are called for.

To help prevent what is hopefully a more balanced and update section from magically disappearing, I have created this discussion to record changes made and offer a place for anyone that deems the section needs to be changed a spot to record changes. - Pbmaise (talk) 03:26, 30 September 2011‎

Would we mention AR-V7 under Management or Research

ASCO: Protein May Help Guide Prostate Cancer Treatment - AR-V7 status may inform choice of taxane, targeted therapy says detection of AR-V7 in blood predicts response to therapy and hence can direct therapy. Could be a new para in Research ? - Rod57 (talk) 16:01, 12 June 2016 (UTC)

Should mention bipolar androgen therapy

bipolar androgen therapy has been studied for CRPC [1] and hormone-sensitive PC [2] and found worthy of further study. - Rod57 (talk) 17:15, 12 December 2016 (UTC)

If all we have is a pilot study, IMO no. Doc James (talk · contribs · email) 19:50, 12 December 2016 (UTC)
agreed. Jytdog (talk) 19:52, 12 December 2016 (UTC)

Removed unclear bit

Am going to remove this sentence: "Prostate cancer affected 18% of American men and caused death in 3% in 2005.[19]"

The figure, 18%, is likely incorrect, though editor may have intended to say something other than what is written. The citation leads one to an abstract that doesn't back up the sentence. Badiacrushed (talk) 02:13, 11 April 2017 (UTC)

The information is dated so I don't object to it being removed, but the source is the the whole article, which is freely available from the pubmed abstract that was linked to, and it did roughly support those figures. I believe that the "18% affected" came from Table 10, which was actually the % of men who got prostate cancer in the period 1999-2001. The 3% death rate came from Table 3 (~30,000 deaths for every 100,000 people) Jytdog (talk) 02:38, 11 April 2017 (UTC)
Currently it is 13% but that belongs under epidemiology[3] Doc James (talk · contribs · email) 17:39, 11 April 2017 (UTC)

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Break even point

I think there are real medical issues involved in the treatment of prostate cancer, related to PSA testing. I also think that one way to objectively state what the benefit/loss point is with PSA testing is something along the lines of stating a PSA level after which treatment is a net benefit and below which treatment is a net loss. This is a very gross kind of analysis but I think is undeniably true. If a group of people all have PSAs over 40, I dont think that there is any question that as a group they will benefit from treatment. A group of people with PSAs under 2, will certainly net suffer as a group from treatment. The switch over balance number, which no doubt not to be used as mandatory in every case, nonetheless removes the discussion from the realm "are doctors only after money" and Never get your PSA tested, into something that would be fact based, and give the very gross picture, less misleading than the current statements, although far from sufficient in any specific case. Maybe the NCCN will do something like this. ( Martin | talk • contribs 21:22, 15 June 2017 (UTC))

What matters is what WP:MEDRS sources say. Please be aware that this page is not for general discussion of the topic, but for improving the article. Jytdog (talk) 05:47, 16 June 2017 (UTC)

JAMA review

doi:10.1001/jama.2017.7248 JFW | T@lk 10:54, 29 June 2017 (UTC)

The View That Prostate Cancer is Mostly Chance

I put this back in, I think it is unjustified to take out this view. Firstly the references are to comments that are discussing the paper that first contends that most prostate cancers are due to chance and are not the primary paper itselft. Furthermore, this page already has many primary sources in it (eg. the entire paragraph about XMRV is just primary sources (references 45-50)). Furthermore, there are many news sources that covered this view so I think it is fair to put it in as a minority opinion. — Preceding unsigned comment added by Jb12345678910111213 (talk • contribs) 22:53, 29 June 2017 (UTC)

The section needs to be updated with better refs. That is not a reason to add more badly sourced content. I will make updating this based on MEDRS refs a priority - we will see what more recent reviews say on these matters. Jytdog (talk) 03:17, 30 June 2017 (UTC)
This is an excellent comment on pubmed commons "The authors confuse mutation incidence with cancer incidence. Furthermore the factors are not additive. Mutations are obviously related to the number of cell divisions, which is well known, but this does not tell anything on the contribution of heredity and environment."
And confirms why we try to use review articles. I have moved the XMRV stuff to the research section. Doc James (talk · contribs · email) 15:17, 30 June 2017 (UTC)
Anyway the paper is basically arguing that prevention is futile for most cases. This is not a main stream opinion but an interesting hypothesis requiring further analysis. Doc James (talk · contribs · email) 15:26, 30 June 2017 (UTC)

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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)

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."[4]

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."[5][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."[6][not in citation given] Where does the additional source[7][8] 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".[9]

"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.[10] QuackGuru (talk) 00:07, 6 March 2018 (UTC)

Support

Oppose

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".[12] QuackGuru (talk) 15:32, 6 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.[1]" QuackGuru (talk) 07:24, 6 March 2018 (UTC)

[1]

References

  1. ^ a b Catalona, William J. (2018). "Prostate Cancer Screening". Medical Clinics of North America. 102 (2): 199–214. doi:10.1016/j.mcna.2017.11.001. ISSN 0025-7125. PMID 29406053.

Support

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. See Screening_(medicine)#Length_time_bias. 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."[13]

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."[14] 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…"[15] 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.[16] 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)."[17] QuackGuru (talk) 04:39, 8 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.[1] The starting age for most people is at age 50 and age 45 among those at high risk.[1]" QuackGuru (talk) 07:24, 6 March 2018 (UTC) (Proposal has been changed. QuackGuru (talk) 16:26, 6 March 2018 (UTC))

References

  1. ^ a b Rendon, Ricardo A.; Mason, Ross J.; Marzouk, Karim; Finelli, Antonio; Saad, Fred; So, Alan; Violette, Phillipe; Breau, Rodney H. (2017). "Canadian Urological Association recommendations on prostate cancer screening and early diagnosis". Canadian Urological Association Journal. 11 (10): 298. doi:10.5489/cuaj.4888. ISSN 1920-1214. PMID 29381452.

Support

Oppose

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)

1st proposal to replace current wording in lead

Replace the following wording: "Prostate cancer screening is controversial.[1][2] Prostate-specific antigen (PSA) testing increases cancer detection, but it is controversial regarding whether it improves outcomes.[1][3][4] Informed decision making is recommended when it comes to screening among those 55 to 69 years old.[5] Testing, if carried out, is more reasonable in those with a longer life expectancy.[6]"

References

  1. ^ a b "Prostate Cancer Treatment". National Cancer Institute. February 6, 2018. Retrieved March 1, 2018. Controversy exists regarding the value of screening... reported no clear evidence that screening for prostate cancer decreases the risk of death from prostate cancer
  2. ^ Cite error: The named reference WCR2014 was invoked but never defined (see the help page).
  3. ^ Cite error: The named reference Catalona2018 was invoked but never defined (see the help page).
  4. ^ "PSA testing". nhs.uk. January 3, 2015. Retrieved March 5, 2018.
  5. ^ "Draft Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force". USPSTF. Retrieved February 28, 2018.
  6. ^ 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.

Proposed wording: "The benefits and risks of prostate cancer screening are controversial.[1] Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances.[2] Prostate-specific antigen (PSA) testing has been questioned as a result of concerns regarding the risk of causing unneeded biopsies and overdiagnosis and overtreatment.[3] Consensus has not been established regarding the usual screening regimen.[1] 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]

[3]"

References

  1. ^ a b Martínez-González NA, Plate A, Senn O, Markun S, Rosemann T, Neuner-Jehle (February 2018). "Shared decision-making for prostate cancer screening and treatment: a systematic review of randomised controlled trials". Swiss medicalweekly. 148: w14584. doi:10.4414/smw.2018.14584. PMID 29473938.
  2. ^ Cabarkapa, Sonja; Perera, Marlon; McGrath, Shannon; Lawrentschuk, Nathan (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. ISSN 2287-8882. PMC 5153437. PMID 27995110.
  3. ^ a b Catalona, William J. (2018). "Prostate Cancer Screening". Medical Clinics of North America. 102 (2): 199–214. doi:10.1016/j.mcna.2017.11.001. ISSN 0025-7125. PMID 29406053.
  4. ^ a b Rendon, Ricardo A.; Mason, Ross J.; Marzouk, Karim; Finelli, Antonio; Saad, Fred; So, Alan; Violette, Phillipe; Breau, Rodney H. (2017). "Canadian Urological Association recommendations on prostate cancer screening and early diagnosis". Canadian Urological Association Journal. 11 (10): 298. doi:10.5489/cuaj.4888. ISSN 1920-1214. PMID 29381452.

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

Support

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)
  • Oppose — The proposed text includes inaccuracies and misrepresents "may help" while disregarding that it equally "may not help". The sentence "Consensus has not been established regarding the usual screening regimen." is simply wrong, because in many countries there is a consensus practice, and if you're going to define consensus as that which is agreed upon everywhere, then you're not going to find much at all. The new text also cherry-picks the Canadian guidelines. I could equally present the Swedish guidelines which are pretty much the exact opposite: "no screening should be performed — testing when a patient has symptoms of BPH and/or a palpable prostate "lump"; or when the patient expresses a strong willingness to test; or has tested before and found an elevated PSA". Carl Fredrik talk 16:25, 10 March 2018 (UTC)

2nd proposal to replace current wording in lead

Proposed wording: "The benefits and risks of prostate cancer screening are controversial.[1] Prostate-specific antigen (PSA) testing has been questioned as a result of concerns regarding the risk of causing unneeded biopsies and overdiagnosis and overtreatment.[2] 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.[3] The starting age for most people is at age 50 and age 45 among those at high risk.[3]

[2]"

References

  1. ^ Martínez-González NA, Plate A, Senn O, Markun S, Rosemann T, Neuner-Jehle (February 2018). "Shared decision-making for prostate cancer screening and treatment: a systematic review of randomised controlled trials". Swiss medicalweekly. 148: w14584. doi:10.4414/smw.2018.14584. PMID 29473938.
  2. ^ a b Catalona, William J. (2018). "Prostate Cancer Screening". Medical Clinics of North America. 102 (2): 199–214. doi:10.1016/j.mcna.2017.11.001. ISSN 0025-7125. PMID 29406053.
  3. ^ a b Rendon, Ricardo A.; Mason, Ross J.; Marzouk, Karim; Finelli, Antonio; Saad, Fred; So, Alan; Violette, Phillipe; Breau, Rodney H. (2017). "Canadian Urological Association recommendations on prostate cancer screening and early diagnosis". Canadian Urological Association Journal. 11 (10): 298. doi:10.5489/cuaj.4888. ISSN 1920-1214. PMID 29381452.

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

3rd proposal to replace current wording in lead

[Please place your proposal here.]

Support

Oppose

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."[18] Source says "Prostate cancer (PCa) screening is controversial."[19] Source says "Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community."[20] 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"[21] 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"[22] 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."[23] 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)

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,[24] 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."[1]

References

  1. ^ Catalona WJ (March 2018). "Prostate Cancer Screening". The Medical Clinics of North America. 102 (2): 199–214. doi:10.1016/j.mcna.2017.11.001. PMID 29406053.
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."[25] Doc James (talk · contribs · email) 03:57, 3 March 2018 (UTC)
A "reversion to more PCa cases being high-grade and advanced at diagnosis"[26] 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".[27] What where the consequences? Notably, "a reversion to more PCa cases being high-grade and advanced at diagnosis."[28] 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)

What reference are you using to support this "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."? Many say the exact opposite. The % of males with "prostate cancer" has dropped in half in the United States over the last 30 years as screening has decreased. Doc James (talk · contribs · email) 17:37, 10 March 2018 (UTC)
diagnosed with - that is all we can say. Johnbod (talk) 17:44, 10 March 2018 (UTC)
Regarding "Correct, most do not die from prostate cancer (but more do now as a result of USPSTF)." — you can't say that. More die as a % of those diagnosed, but in absolute terms no more are dying — or at the very least no such correlation has been made based on evidence.
Such statements are fraught with confounding factors, and even if more men die from prostate cancer today than 10 years ago, that could be because life expectancy is higher, and mortality from cardiovascular disease is down.
We need to stick with the highest possible standards of evidence, and unfortunately much of the current discussion is driven by emotion. Carl Fredrik talk 18:32, 10 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.[29] 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)
There are adverse outcomes beyond radical prostatectomy, including: unnecessary fear and anxiety, biopsy, and adverse outcomes of biopsy such as infection, bleeding, and in some cases death. Carl Fredrik talk 18:36, 10 March 2018 (UTC)
Agree with CFCF the concerns with screening do not pertain to death from prostate cancer (may be slightly decreased) but increased harm due to unneeded testing and treatment. Doc James (talk · contribs · email) 21:20, 12 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)

Can we use a new (but old enough to be WP:MEDRS) screening review please?

I'd prefer that all references to old, bad guidelines, whether they were, are, or might still in the future be controversial, and pretty much all the previous article issues discussed on this page be replaced with a summarization of e.g. [30] instead. Here's its abstract:

In this chapter the use of prostate specific antigen (PSA) as a tumor marker for prostate cancer is discussed. The chapter provides an overview of biological and clinical aspects of PSA. The main drawback of total PSA (tPSA) is its lack of specificity for prostate cancer which leads to unnecessary biopsies. Moreover, PSA-testing poses a risk of overdiagnosis and subsequent overtreatment. Many PSA-based markers have been developed to improve the performance characteristics of tPSA. As well as different molecular subforms of tPSA, such as proPSA (pPSA) and free PSA (fPSA), and PSA derived kinetics as PSA-velocity (PSAV) and PSA-doubling time (PSADT). The prostate health index (phi), PSA-density (PSAD) and the contribution of non PSA-based markers such as the urinary transcripts of PCA3 and TMPRSS-ERG fusion are also discussed. To enable further risk stratification tumor markers are often combined with clinical data (e.g. outcome of DRE) in so-called nomograms. Currently the role of magnetic resonance imaging (MRI) in the detection and staging of prostate cancer is being explored.

Sadly that one is behind a paywall, and I'm not comfortable putting it in the article if an open access substitute is good enough for patient researchers. I think it's distasteful to cite paywalled articles that the most vulnerable are likely to open their wallets to read.

Is there a suitable open access substitute? Bexoen (talk) 20:14, 10 March 2018 (UTC)

That ref is PMID 26530362 and is indeed fine. However the section on screening here should just be the WP:LEAD of Prostate cancer screening with refs added, per WP:SUMMARY and WP:SYNC. In that article, the section on PSA should in turn be the lead of the Prostate-specific antigen with refs added, again per WP:SUMMARY and WP:SYNC. Doing this right, we update PSA, then the screening article, then this last. Jytdog (talk) 20:29, 10 March 2018 (UTC)
That is a MEDRS source and can be used, but not to the exclusion of other, or more recent, sources (that is how bias is created). Note that a book published in 2015 will contain research considerably older than 2015, and we have 2016 and 2017 reviews.

Jytdog is right that the sub-articles should all be addressed first so they can be used as building blocks for this article, which should use Summary Style, but there are many more articles than just PSA and screening-- for example, there is a biopsy article, prostatectomy, and staging which are all also dismal. Optimally, they would all be updated before this article is addressed, and at the end of that process, we end up with the lead to this article.

With respect to SYNC, it offers a suggestion that rarely works in practice in higher level, well-written articles. Note that the wording of the guideline (my emphasis) is "it can be convenient to use the sub article's lead"-- that is not even a recommendation. It is a helpful suggestion for beginning editors or for new suites articles, but rarely works in practice for more advanced content. How useful that suggestion is depends on how the top summary article is organized. SandyGeorgia (Talk) 13:43, 16 March 2018 (UTC)

Outdatedness is not bias. It is just outdatedness. But yes we should use the most recent, highest quality refs, always. Especially on this topic where we have a lot of unusual intensity.
And yes, all the sub-articles need to be updated so we can feed them into the main article.
I have found that bringing the lead over is the most simple/rational way to handle the SYNC/SUMMARY thing, as a rough starting point; yes any given actual lead often needs to be tweaked once it is brought over, in order to make it fit well into its actual new context. Those tweaks also need to stay in tune with the subarticle. Jytdog (talk) 14:05, 16 March 2018 (UTC)

OPPOSE 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)

Citations in the lead

We typically add references to the lead for medical articles. This lead is similarly referenced to 100s of other medical articles. Doc James (talk · contribs · email) 17:36, 10 March 2018 (UTC)
Well, then IMO something is wrong with writers of medical articles so that they do not follow WP:LEAD. Alternatively, something is wrong with WP:LEAD: if there are too many exceptions from a rule, time to rewrite the rule based on community experience. Staszek Lem (talk) 16:27, 12 March 2018 (UTC)
For context, User:Staszek Lem, it's my understanding that to hasten broad coverage of our medical content in other languages, the translation project has often been translating only the lead of many articles. To facilitate that in turn, several of us have been insuring that everything in the lead of medical articles is sourced. It is true that WP:LEAD says they are not necessary and that remains true. But for this purpose they are very useful. And I agree that in other contexts, lots of refs in the lead is a sign of trouble. It isn't, in medical articles. We should add a note about this to MEDMOS. Jytdog (talk) 16:34, 12 March 2018 (UTC)
Not only MEDMOS, but WP:LEAD as well. Just you wait until some zealous wikignome decides to "clean up" these overfootnoted leads brandishing the guideline into your face. Happened with me quite a few times. Staszek Lem (talk) 16:42, 12 March 2018 (UTC)
WP:LEAD says "The verifiability policy advises that material that is challenged or likely to be challenged, and direct quotations, should be supported by an inline citation. Any statements about living persons that are challenged or likely to be challenged must have an inline citation every time they are mentioned, including within the lead.... The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus."
There is no "prohibition" of references in the lead. Local consensus is at WP:MEDMOS were use is supported. Doc James (talk · contribs · email) 21:18, 12 March 2018 (UTC)
No, we need not include citations in lead, and forcing them (and 12-yo language) into leads for a different project (translation) not only results in less than optimal leads-- it also has resulted (as in this suite of articles) in important parts of the bodies of articles being neglected. The lead is a summary of the whole article-- not a select set of facts that are for translating on a 12-yo level. And, the problem in THESE articles is just that ... the leads do not summarize the articles, do not summarize the conditions, and reflect select cherry-picked facts for translation.

Further, with respect to MEDMOS and MEDRS, we had to jump through quite a few hoops back in the day to get those pages accepted as guidelines, and part of getting them accepted was making sure that they did not contradict project-wide guidelines, like LEAD and MOS. MEDMOS needs to stay in sync with the rest of the project, or we risk their acceptance as guidelines. This "local consensus at MEDMOS" is overridden by project-wide guideline.

This line of thinking drives down the overall quality of medical articles, with attention focused on making them readable at a 12-yo level so they can be translated, and is perhaps is why the growth here has stalled. SandyGeorgia (Talk) 13:26, 16 March 2018 (UTC)

Or maybe FA has stalled because many people (like me) do not care about these badges. There is so much work to do always, with just basic maintenance like keeping things updated. Jytdog (talk) 14:45, 16 March 2018 (UTC)
I have also received similar pushback about references in the lead of medical articles citing this style guide. I agree that it should be addended to avoid further confusion since many editors who primarily work outside of the medical project are unaware of the above caveats. TylerDurden8823 (talk) 16:01, 16 March 2018 (UTC)
I agree with Jytdog here, the decrease in medical FAs has nothing to do with not reaching FA requirements. Rather it is that our own requirements are nearly always far beyond what FA requires, and getting referenced ledes through FAR has not been a problem. The reason no one is working on FAs for medical articles is that the effort to reward ratio is awful. So what if it's featured on the main page when the article gets 30.000 views a day as it is? WPMED quality control is frankly better than FA, and GA is horrible. I've seen articles that are extremely factually inaccurate reach GA. Carl Fredrik talk 15:58, 19 March 2018 (UTC)
I tend to agree - Sandy, as you keep saying there are so many terrible medical articles, even dangerously so, and at the point where a big medical article has been got to be accurate and up to date in essentials, editors are presented with the choice of going on and doing that to probably at least 2 more articles, or spending the same amount of effort taking the first one through FA. Given the wholly different importance of the articles to many readers (another point you rightly keep making), it's understandable if people choose the first path. I have to say I've pretty much given up writing my own FAs, though I still review some, as I think this argument applies even to art history - it's just more useful to get a series of bad articles up to a decent standard, and leave them there. I personally support the emphasis on leads, not just for translation purposes, but for a high proportion of our English-speaking readers, who seem to include great numbers of second-language English speakers, who prefer (trust) English WP over say the Polish or Spanish one, though they may look at that as well. Many only read the lead, plus maybe one or two sections that especially interest them, before moving on to other internet sources, as my research at CRUK showed. Johnbod (talk) 16:23, 19 March 2018 (UTC)

STAMPEDE

@Zefr: STAMPEDE started in 2005 and results for phase 1 and 2 have been reported. These results are affecting treatment decisions and are used as justification for those decisions. This can hardly be called "WP:RECENTISM, unencyclopedic", perhaps a perusal of the reports in The Lancet might clarify things for you? Of course if you believe there is a better place in the article to link to research than this section, feel free to move the link there. Martin of Sheffield (talk) 21:57, 12 October 2019 (UTC)

STAMPEDE (clinical trial) could be in 'see also'. I think information from a result of the trial would be needed for a mention in the body of this article, or at least some information. Johnuniq (talk) 22:11, 12 October 2019 (UTC)
There are reported results given at STAMPEDE_(clinical_trial)#Results. Do you want the whole section copied over? Martin of Sheffield (talk) 22:13, 12 October 2019 (UTC)
Martin of Sheffield: There appear to be no reviews on its use for diagnosis, or even if the therapy regimens under study are effective in a sufficient population to warrant clinical or regulatory approval. There is a 70% failure rate for Phase II and 50% failure of Phase III trials. IMO, it is unencyclopedic to include research-in-progress; WP:MEDREV. --Zefr (talk) 22:19, 12 October 2019 (UTC)
@Zefr: I'm suprised at that comment. I followed the link you provided and the first entry was Woods, BS; Sideris, E; Sydes, MR; et al. (September 14, 2018), Addition of Docetaxel to First-line Long-term Hormone Therapy in Prostate Cancer (STAMPEDE): Modelling to Estimate Long-term Survival, Quality-adjusted Survival, and Cost-effectiveness., US National Library of Medicine National Institutes of Health, retrieved October 13, 2019 in which the abstract contains: "CONCLUSIONS: Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available. PATIENT SUMMARY: Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body." Now I'm not a doctor. I came to this trying to understand the letter from my oncologist to my GP which referred to STAMPEDE results as the basis for the proposed course of treatment. This is Wikipedia, a public encyclopaedia, to which anyone should be able to turn to find out information and where to go for details. I do note that the abstract quoted above reports the STAMPEDE in an official US government publication, so the work has been noted outside of the UK. As I said originally, feel free to insert the summary or link where you, Johnuniq and other medics consider most appropriate. Regards, Martin of Sheffield (talk) 10:09, 13 October 2019 (UTC)
Martin of Sheffield: your reasoning is understandable and I regret to see your diagnosis and treatment; best of luck as you proceed. The article quotes you provided are not definitive for an encyclopedia; STAMPEDE is still a work-in-progress. Wikipedia does not provide clinical guidance or advice, WP:NOTADVICE, but rather has the goal of stating the best-established facts, as discussed in WP:MEDASSESS, where the "level of evidence" concerning the STAMPEDE program is not yet universally accepted or critically reviewed where it has broad consensus in the clinical community, WP:MEDSCI. Other editors may disagree, so let's allow the discussion to unfold. --Zefr (talk) 16:45, 13 October 2019 (UTC)
I agree; the whole "research" section could do with an update. Best of luck with the treatment. Johnbod (talk) 03:25, 14 October 2019 (UTC)

Nonsurgical treatments

I added a section to the nonsurgical treatments about the impact of early and late hormone therapy for hormone-sensitive treatment using information from a Cochrane review. I also created a heading for the castrate-resistant prostate cancer section to more easily differentiate between the treatments for both types of prostate cancer. --Gsom12812 (talk) 14:52, 22 February 2021 (UTC)

Cochrane Edits

Added a sentence comparing cryotherapy to radiation treatment for prostate cancer with results from a Cochrane review --Gsom12812 (talk) 14:43, 24 February 2021 (UTC)

Added from three Cochrane reviews: - A section on hypofractionation as a type of radiation treatment - A comparison of diagnostic techniques for prostate cancer - A paragraph on using taxane-based chemotherapy in addition to hormone therapy These edits improve the quality of information about potential treatments to medical issues relating to prostate cancer. --Gsom12812 (talk) 16:36, 24 February 2021 (UTC)

Gsom12812 I have reverted your additions for multiple reasons, the most serious being cut-and-paste WP:COPYVIO from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483565/, which by the way, is the most recent version of the dated Cochrane study you were citing. Please provide PMIDs in your citations; I could have saved a lot of time if I could have gone straight to the correct review; the most recent is 31022301, while I could not locate the older one you were citing in PUBMED. Also, please review and respect WP:CITEVAR; this article uses the Diberri-Boghog template, https://citation-template-filling.toolforge.org/cgi-bin/index.cgi which generates a citation template by plugging in the PMID:
Also, please see MOS:BOLD and MOS:BADITALICS. And before I had to revert the whole thing as cut-and-paste plagiarism, please review the changes I had made [31] to reduce excess detail.
Further, considering that management of prostate cancer exists, this is mostly excess detail in this article. SandyGeorgia (Talk) 18:58, 24 February 2021 (UTC)
SandyGeorgia Thank you for giving me this feedback. I am working as a part of the Cochrane-Wikipedia project to bring the results from a number of Cochrane review papers on prostate cancer to the relevant Wikipedia pages. As I continue to work with them, I will likely have to add in the information from the edits you reverted again and so I wondered if you would be able to give me an idea of how to do this more effectively so as to not have these edits reverted in the future. Is there a way to make it clearer that I am using this information with Cochrane's permission and am thus paraphrasing essentially all of the information from the plain language summaries provided in the Cochrane articles? As for the citation, I apologize for the time it took you to find the review. I am using the DOIs provided me by Cochrane to create the citation with Wikipedia's tool. I will try to find if there are updated versions of the articles I am provided in the future. --Gsom12812 (talk) 15:16, 25 February 2021 (UTC)
Gsom12812 please see discussion at Talk:Management of prostate cancer, here.. SandyGeorgia (Talk) 22:32, 25 February 2021 (UTC)

Rephrased comparison between prostate cancer diagnosis techniques and added it back to the relevant sections. Replaced information from individual studies with the updated information from the Cochrane review.Gsom12812 (talk) 03:12, 27 February 2021 (UTC)

In collaboration with the Cochrane-Wikipedia project, I added information from a Cochrane review article that compared bone-modifying agents as treatment for men with prostate cancer and bone metastases. --Gsom12812 (talk) 15:00, 25 February 2021 (UTC)

Study sponsored by Dairy Organization in Spain

From this edit, moved from article for examination of sourcing:

A 2019 overview of systematic reviews and meta-analyses argued that while there was evidence that linked milk to higher rates of prostate cancer, the evidence was inconsistent and inconclusive.

Source López-Plaza B, Bermejo LM, Santurino C, Cavero-Redondo I, Álvarez-Bueno C, Gómez-Candela C (May 2019). "Milk and dairy product consumption and prostate cancer risk and mortality: an overview of systematic reviews and meta-analyses". Adv Nutr. 10 (suppl_2): S212–S223. doi:10.1093/advances/nmz014. PMC 6518142. PMID 31089741.

This report is sponsored by the Dairy Association in Spain. WhatamIdoing could you comment on the journal and the suitability of this source? SandyGeorgia (Talk) 01:40, 18 March 2021 (UTC)

It's a highly rated journal.[32] The article itself has been cited at least eight times. WhatamIdoing (talk) 01:58, 18 March 2021 (UTC)
Thanks, WAID, will reinstate then. SandyGeorgia (Talk) 02:04, 18 March 2021 (UTC)

PSA screening

Sexual activity

Two reputable medicine schools, namely, the Mayo Clinic and Johns Hopkins University, diverge on the question of whether frequent ejaculation prevents prostate cancer:

1) https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prevention

2) https://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer/faq-20057800

Who's right? I,SphericalEarther (talk) 07:11, 24 October 2021 (UTC)

Wiki Education Foundation-supported course assignment

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— Assignment last updated by Nneiman1 (talk) 16:04, 21 September 2022 (UTC)

Epidemiology

PMID 35468227 may be helpful to anyone who wants to update the statistics in this article. WhatamIdoing (talk) 22:24, 2 February 2023 (UTC)

First sentence of lead

I came here when I discovered a conflict over the wording to use. It would be nice to discuss this and achieve a solid consensus, so let's look at the situation.

1. The long-standing version is a silly tautology. No matter how long that version was in place, it should not be tolerated:

  • Prostate cancer is cancer of the prostate.[1][2] Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men.

2. Reywas92 pointed out that stupid situation and fixed it here:

3. While there is no rule that requires the first words must exactly repeat the title of the article, when it's possible to do so in a natural manner, it is usually best to do so. That would produce this version:

  • Prostate cancer[5][6] is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men.

So which one is preferred, 1, 2, or 3? -- Valjean (talk) (PING me) 15:50, 17 March 2023 (UTC)

Hi @Valjean, CV9933, and Reywas92:, I'm sorry to be late to the party. I've been updating this article, and will end by updating the lead. Any objections to a slight tweak: "Prostate cancer is a cancerous tumor that begins in the prostate. It is the second most..."? The reason being that there actually is a slightly non-intuitive definition to "prostate cancer". If a tumor starts in the prostate, it's prostate cancer. If it starts elsewhere, say the bladder, and intrudes into the prostate, we call it "bladder cancer". This would then be consistent with Lung cancer which now opens "Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung." Idk if folks prefer "malignant tumor" or "cancerous tumor". Makes no difference to me. Thoughts? Ajpolino (talk) 04:01, 26 June 2023 (UTC)

Primary tumor might be a useful link in this case but generally I agree with your proposal. CV9933 (talk) 10:10, 26 June 2023 (UTC)
I don't think this is necessary because the current version is "cancer of the prostate" rather than "cancer in the prostate". That first sentence is still too tautological. Could also be simply changed to "Cancer that begins in the prostate is the second most common cancerous tumor worldwide..." Reywas92Talk 13:46, 26 June 2023 (UTC)

References

  1. ^ "Prostate cancer - Symptoms and causes". Mayo Clinic. Retrieved February 11, 2023.
  2. ^ "What Is Prostate Cancer?". www.cancer.org. Retrieved February 11, 2023.
  3. ^ "Prostate cancer - Symptoms and causes". Mayo Clinic. Retrieved February 11, 2023.
  4. ^ "What Is Prostate Cancer?". www.cancer.org. Retrieved February 11, 2023.
  5. ^ "Prostate cancer - Symptoms and causes". Mayo Clinic. Retrieved February 11, 2023.
  6. ^ "What Is Prostate Cancer?". www.cancer.org. Retrieved February 11, 2023.

Coverage of PET

Just pinging Beevil on this since you previously objected to a PET-related removal and edited the section. I'm working my way through the Diagnosis material, trying to update and make things flow smoothly for a non-expert to understand. I just incorporated some of your PET wording into a paragraph on spread, and removed the play-by-play that seemed undue ("In 2020, X was approved. In 2021, Y was approved"). Wanted to flag it in case you had comments, criticisms, or concerns. Ajpolino (talk) 14:32, 28 May 2023 (UTC)

Added another mention in Management#Localized disease Ajpolino (talk) 21:35, 28 May 2023 (UTC)
Thanks for letting me know, I think the changes are generally good - there was too much detail in the Diagnosis section before. Beevil (talk) 18:32, 27 June 2023 (UTC)

Unconfirmed risk factors

@Ajpolino I guess it's the question, if the systematic reviews systematically mention these studies, but also mention that they are unreliable, weak evidence, is it worth discussing them in the article? I think it's worth mentioning them, if only to say that the studies aren't worth much. Echoing this, WP:MEDDATE mentions "an older primary source that is seminal, replicated, and often-cited may be mentioned in the main text in a context established by reviews." At least for these studies, the replicability part is doubtful, although I guess we could consider multiple studies finding similar results to be replication, but they do have a fair number of citations, and the "seminal" part (what a pun) is suggested by the fact that they continue to appear in SR's. Mathnerd314159 (talk) 19:42, 21 June 2023 (UTC)

Hi Mathnerd314159, I'm sorry to be a pain, and I think my edit summary was so short as to be unclear. I think it's fine for our articles to cover areas with conflicting results. But I think some of the risk factors covered in that systematic review are so poorly covered that to dedicate text to them in an article on "Prostate cancer" is undue. Baldness is the extreme example: the 2021 Nature Reviews Diseases Primers article, 2021 Lancet article, and Harrison's Internal Medicine chapter which are all extensive mainstream articles on "Prostate cancer" don't mention baldness at all. Even articles specifically on epidemiology of prostate cancer rarely bring up baldness. The topic of prostate cancer risk factors is HUGE and the subject of immense study. More risk factors and detail would no doubt be due in an article on Risk factors for prostate cancer (we do have a Risk factors for breast cancer!) but here I think it muddles the reader's image for relatively little gain.
Somewhat similarly, I vaguely recall hearing on the radio 10+ years ago that men who masturbate more frequently are at reduced risk of developing prostate cancer. Recently I've been going through sources updating this article, and I'd sort of hoped to find great coverage either for or against the association that I could clarify here. But it seems to be similarly murky and has attracted relatively little coverage, and so I've decided it's probably undue as well :/ If you're interested in the topic and want to start Risk factors for prostate cancer, let me know and I'll happily help out and can send the sources I've been digging up for the Prostate cancer update (hey there's probably room there for the masturbation bit as well). Ajpolino (talk) 20:30, 21 June 2023 (UTC)
Oh and I don't know if this page has many watchers, you're the first person to substantially pop by in the few months I've been working on it. So if you vehemently disagree with me on this (totally fine!), perhaps we can post at WT:MED to try to solicit a few more opinions. Ajpolino (talk) 20:31, 21 June 2023 (UTC)
Yeah, I just clicked through to prostate cancer from masturbation a few days ago to see if there was more information and then I noticed the prostate cancer article didn't mention anything at all and it had been removed. It's like a lot of Wikipedia, someone writes it and then it never gets touched, and the resulting coverage is rather inconsistent. Page Info says 13 editors looked at recent edits in the past 30 days but I'm guessing they're mostly large-scale watchers worried about vandalism.
Splitting the risk factors out does seem like a good idea, the article did shrink a bit with your recent edits but it's good to have room for it to expand back up. I guess I can start it, or do you want to? I really haven't looked at much beyond the 2022 update article. Mathnerd314159 (talk) 00:12, 22 June 2023 (UTC)
You're most welcome to start it any time. I'd love to, but sadly I barely have the bandwidth to keep chugging through this update. I'm mostly working top-to-bottom updating the sources to high quality reviews and textbook chapters from the last five years. I'm at the top of the Prognosis section now. I'll do the images and lead last. I'm hoping to nominate the article at FAC later this summer (I did a big lung cancer update this spring. That's the most lethal cancer; this is the second most lethal. That's how I ended up here). You're of course most welcome to participate in any part of the process. If instead you want to dig deeper into risk factors, I'm happy to support however I can. If you see any sources in this article (or elsewhere) you'd like I can send you a copy. If there's any other way I can help just let me know. Ajpolino (talk) 02:21, 22 June 2023 (UTC)
Well, I was going to just write it, but I started and then I realized it was a lot of work, more than just a few days. So my current progress is in the draft Draft:Risk factors for prostate cancer. I should have time to come back to it in a week or two. I would say to discuss the draft on its talk page. I haven't had much problem with accessing sources so far, the issue is more that the statistics I want aren't published. Mathnerd314159 (talk) 04:39, 29 June 2023 (UTC)
@Ajpolino regarding epidemiology vs risk factors, I think I'll discuss both in the risk factors article, so I would say to try to combine those sections. Mathnerd314159 (talk) 03:36, 2 July 2023 (UTC)

2017 systematic review

Hi FULBERT, I'm sorry to revert your recent addition to Prostate_cancer#Supportive_care. I understand it's tempting to add everything new and useful to its relevant article, but here I don't think the text from that review really added any information for the reader to this article.

A 2017 systematic review of the literature found that while most studies focus on treatment options oriented toward survival, there was little evidence that assessed patient-centered outcomes concerned with comparative effectiveness of treatment.

First, I suppose this is more a conclusion about "Prostate cancer research" than "Prostate cancer supportive care" (i.e. the authors are concluding that prostate cancer researchers have understudied patient-centered outcomes beyond survival). But more importantly I think the authors' conclusion doesn't really merit a full sentence in our summary of prostate cancer care (codified at WP:PROPORTION). If you disagree, I'm happy to discuss further and we can reach out for more folks' opinions. Happy to hear any other thoughts/concerns you may have about the article as well. Cheers. Ajpolino (talk) 02:10, 1 December 2023 (UTC)

@Ajpolino Thank you for your feedback. FULBERT (talk) 02:20, 1 December 2023 (UTC)

GA Review

Passed. —Femke 🐦 (talk) 19:46, 20 March 2024 (UTC)

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

GA toolbox
Reviewing
This review is transcluded from Talk:Prostate cancer/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Femke (talk · contribs) 09:24, 3 March 2024 (UTC)


Will be taking this on this week. I did a first read-through of the article, and in most places the prose is excellent. Are you planning to take the article to FAC? Happy to nit-pick a bit more if that's the plan. Initial thoughts:

  • "Most cases are detected after screening tests – typically blood tests for levels of prostate-specific antigen (PSA) – indicate unusual growth of prostate tissue" --> This is awkward because the first sentence fragment (Most cases.. tests") feels like a complete sentence. The verb indicate then comes as a surprise. My first intuition was to replace "after" with "when", but perhaps this loses precision as the actual detection happens with a biopsy(?). ChatGPT suggested: "Abnormal growth of prostate tissue is usually detected through screening tests, typically blood tests that check for prostate-specific antigen (PSA) levels"
    • I tried a few different wordings, but actually I quite like the ChatGPT one. Added another sentence after to clarify. Let me know if I've made it clunky.
  • In particular, many measure "free PSA" – the around 10–30% of PSA unbound to other blood proteins --> the combination "the" and "around" makes for awkward prose. A bit more wordy: free PSA" – the fraction of PSA unbound to other blood proteins, which is usually around 10% to 30%.
    • Done.
  • As those severely ill with metastatic prostate cancer near the end of their lives, most experience confusion and may hallucinate or have trouble recognizing loved ones --> the word near here can be read both as a verb and a adverb. Approach may be clearer.
    • Done.
  • I would add a linking word (such as However) before "Analyses of internet searches..". It took me a second read to understand the second sentence meant to contrast the first.
    • Done.
  • No source for the blue ribbon.
    • It has been weirdly difficult to source. Google prostate cancer ribbon and you'll see they're light blue. But I've struggled to find a good source for it. The Prostate Cancer Foundation calls its donor group the "blue ribbon society" but they don't just out and say the thing I need them to say. Here's a WebMD article that states it clearly? I know WebMD makes the medicine folks cringe. Alternatively I can just cut it out. Perhaps if no one talks about it, it's just not that important. What do you think?
      • I think either option is fine, leaning towards your solution of cutting it out. In Google News search "pink ribbon breast cancer / blue ribbon prostate cancer", I get our classical HQRS for breast cancer, but not for prostate cancer, implying it's not that important. I don't mind WebMD for completely unambigious things like this. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)

—Femke 🐦 (talk) 09:24, 3 March 2024 (UTC)

Hi Femke, thank you for taking up the review. I'm traveling this weekend but should be back in business in a day or two. I am indeed hoping to bring this article through FAC, so any nitpicking you're willing to do is much appreciated. Thanks again! Ajpolino (talk) 12:57, 3 March 2024 (UTC)
Brilliant. I'll put optional where it's not needed for GA, but may be good for FA. —Femke 🐦 (talk) 14:30, 3 March 2024 (UTC)
  • Explain vas deferens?
    • Added parenthetical "(the duct that delivers sperm from the testes)". Is that alright? If I add where it delivers the sperm to, I'll have more jargon (in case you're curious, here's a nice diagram. It joins with the end of the seminal vesicles to form the ejaculatory duct, which dumps into the urethra in preparation for an orgasm. Takes a surprising number of moving parts to get the job done).
  • The article doesnt't talk too much about side effects of treatments other than surgery, might be good to expand on this (optional). I imagine that low testosterone levels may have quite significant side effects?
    • They do. Will add something.
  • or a rapid rate of PSA level increases --> or quickly rising PSA levels.
    • Done.
  • and eventually can kill the affected person --> word order, can eventually may be better. Or simply can.
    • Went with your first suggestion.
  • "Some PINs continue to grow, forming layers of tissue that stop expressing genes common to their original tissue location – p63, cytokeratin 5, and cytokeratin 14 – and begin expressing genes common to cells that makeup the innermost lining of the pancreatic duct." --> make up should be two words. The last bit might be better expressed as "and instead begin expressing genes typical of cells in the innermost lining of the pancreatic duct".
    • Done.

Source check

I check sources when I'm surprised by the facts or when I don't understand the text fully, and supplement this with a few random searches if the text is clear.

  • As a tumor grows beyond the prostate .. Works out, but source indicates some people may already have trouble urinating in the early stages. Might be good to mention for comprehensiveness (optional)
    • It's gently controversial, but I've worded it in a way that I think captures the mainstream consensus. I like to use the American Cancer Society pages as sources early in sections because I think they're nicely understandable to layfolk, and typically up-to-date. Here I think they overstepped a bit with their wording, but perhaps I should either dutifully follow them or find an authoritative source more in line with the current wording.
  • Advanced prostate tumors often metastasize to nearby bones of the pelvis and back --> the first bit of the sentence does not seem covered by this sentence.
    • Note to self to tweak wording to match Rebello Fig. 3C.
    • Added a ref and tweaked the wording to match. It now says particularly in the pelvis, hips, spine, ribs, head, and neck. My question for you: is the list now long enough that it's uninteresting? I could just leave it at "lymph nodes and bones". I'm trying to get across something curious about prostate cancer, which is that it metastasizes to bones a lot, and prefers some bones over others (basically it prefers bones of your torso and head rather than the limbs). Contrast with lung cancer, which metastasizes to many organs. Happy to hear your thoughts on what's clear and interesting.
  • This is done through blood tests.. I don't have access to the Nature paper, but the CDC seems to put the digital rectal exam and the PSA test on equal footing for screening. THe other source is higher-quality, so good to defer to that one.
    • The Rebello source is available through The Wikipedia Library (I'll throw in a plug for User:Smartse's Redirector extension rules, mentioned here, which I find to be a great convenience). It says frankly "Screening methods primarily involve measurements of the blood serum biomarker PSA". I understand what you mean, but I don't think they're meant to be presented on equal footing. The CDC site only gives DREs two sentences, one to explain what they are, and the other to explain that they aren't recommended because they don't seem to help.
      Apologies, I did not properly read the text under the heading. You're absolutely right. —Femke 🐦 (talk) 19:29, 8 March 2024 (UTC)
      And thanks for the link so Smartse's extension thingie. The one I tried out a few years back didn't work for me.
  • Those with PSA levels below average are very unlikely to develop dangerous prostate cancer over the next 8 to 10 years Correct
  • The average man's blood has around 1 nanogram (ng) of PSA per milliliter (mL) of blood tested The text says median, and given the numbers in the paper, I think this distribution is heavy-tailed. That is, the median is likely lower than the average/mean. If you want to avoid the word median, typical may be a good translation.
    • Sure, changed to "typical".
  • Those at higher risk may receive treatment check
  • In their last few days.. check
  • Particularly large PINs can eventually grow into tumors. I can't find it in the source; however, the source has a lot of technobabble I do not understand.
    • Softened the wording to Some PINs can eventually grow into tumors and added a source that notes "high-grade PIN is considered a pre-cancer of the prostate, because it can turn into prostate cancer over time" (I decided not to make the low-grade vs. high-grade distinction in this article because I don't think it's important enough to merit inclusion. The section is already pretty jargon rich.)
  • and mutations that hyperactivate FOXA1 (up to 5% of tumors). check
  • Analyses of internet searches.. --> the source says it doesn't increase much, but a small increase was observed.
    • I've made the smallest change to "neither event changes the level... much,". Happy to more boldly reimagine (or even remove) this if you think it's best.
  • Prostate cancer is a major topic of ongoing research – the U.S. National Cancer Institute (NCI, the world's largest funder of cancer research) spent $209 million on prostate cancer research in 2020 – the sixth highest among cancer types. Check, but 2021 data is out now; it's now the 4th-highest :). The weird doubling in brain&CNS research funding for 2020 seems to have been a blib.

—Femke 🐦 (talk) 17:51, 5 March 2024 (UTC)

    • Excellent! Updated.
The lead is missing citations. Each sentence in a medical article, including the lead, should have a citation. Readers should not have to search for relevant text or relevant citations within the document. Please see discussions about citations at WT:MED, WP:MEDMOS, WP:MEDRS, and WP:MEDCITE. -- Whywhenwhohow (talk) 19:12, 9 March 2024 (UTC)
Lead citations are optional, also for medical articles. Of the links you gave, only the essay WP:MEDCITE says it's adviseable to add citations to the lead in medical articles (as medical article's leads are more likely to be translated). A GAN is not the location to argue this. You probably want to create consensus in a guideline for this instead. —Femke 🐦 (talk) 09:20, 10 March 2024 (UTC)
I started a discussion at WT:MED#Citations --Whywhenwhohow (talk) 17:20, 10 March 2024 (UTC)

Second reading

Lead

  • Those whose cancer spreads ... --> would the first "that" better replaced with which?
    • Done.
  • Eventually cancer cells .. The text makes it seem this always happens. Is that correct? If so, a statement that (only) castration-resistant prostate cancer is incurable in the body feels a bit odd, as the previous stage already leads to CRPC.
    • Added "can".
  • Last sentence lead is bit too wordy. I don't find Nobel Prizes lead-worthy myself, but opinions will vary. If you include it, it can be condensed. Something like: "For their breakthroughs in hormone therapies for prostate cancer, Charles B. Huggins received the 1966 Nobel Prize, and Andrzej W. Schally the 1977 Nobel Prize." It's clear which Nobel Prize is meant.
    • I've changed the wording to a version of your suggestion.

Diagnosis

  • help assess --> assess?
    • Done.
  • I didn't understand the paraphraph on the Gleason grading system. In particularly, what is meant by "common pattern" or second-most common pattern.
    • Hmmm... thinking about how to reword. Basically imagine you're looking at a prostate biopsy. In most of the biopsy you see tissue that looks somewhat cancerous, in one or two places you see tissue that looks very cancerous. You assign two scores: one for the phenomenon you saw the most of (the somewhat cancerous), and a second for the phenomenon you saw the second most of (the very cancerous). Even though you add them together to get a final Gleason score, the order sometimes matters -- a 4+3 (more cancerous tissue is most common) is considered differently than a 3+4 (less cancerous tissue is most common). The source uses the word "pattern" but I agree it's opaque. Any suggestions?
    • Would it be any clearer to change it from the pathologist assigns a number from 1 (most similar to healthy prostate tissue) to 5 (least similar) for the most common pattern observed under the microscope, then does the same for the second-most common pattern. The sum of these two numbers is the Gleason score. to the pathologist assigns scores of 1 (most similar to healthy prostate tissue) to 5 (least similar) to different regions of the biopsied tissue. The sum of the most common two scores is the "Gleason score", ranging from 2 to 10.? Some tweaking would still be required for the grade group explanation below.
      • I sort of guessed right what was meant. I think what makes it different for me to understand is the scale and nature of these "patterns" or phenomena.. Is it cells that have a different pattern? Or bigger regions? The word region answers the scale question a bit: it is bigger than cells, right? This may tie into the micrograph question. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
        • Yep, bigger regions. It's not a single cell that would look cancerous per se, rather clumps of cells that would look funny and be arranged in an unusual way. Ajpolino (talk) 20:41, 13 March 2024 (UTC)
        • Well I've implemented a version of the above. Hopefully it's at least a step in the right direction. Take a look and let me know what you think. Ajpolino (talk) 21:22, 15 March 2024 (UTC)
  • The micrograph image should be connected better to the text. Micrograph is jargon: can we say microscopic image or is that something else? I don't understand what is shown on the image. Is it a biopsy? What is a perineural invasion? How can I see that in the image?
    • Note to self to look for a better image (or to tie this one into the text better).
    • I've spent a few hours poking around at images, and I'm not sure I can clearly illustrate the histology with just one image. I've tried out a replacement image showing some of the imaging done to detect if the cancer has spread. Let me know if you think that's helpful. Ajpolino (talk) 20:53, 19 March 2024 (UTC)

Management - Prognosis

  • The first line of treatment --> awkward going from singular to plural. You could say "involves" rather than is?
    • Done.
  • The if needed in the first sentence feels a bit odd. Normally, I think we use that wording when something become more intense, right? "as needed" may be more appropriate here?
    • Done.
  • An alternative is the cell therapy .. -> can we omit "into the same person"
    • Sure, done.

Cause - Epidemiology

  • "Eventually, tumor cells develop the ability" --> always? (similar to lead)
    • Added "can" as above.
  • Metastases cause most of the discomfort --> needed in cause? Feels more like management (which covers this already)
    • The way I see it is that this section explains both "what causes a tumor to form in your prostate", and "what causes a prostate tumor to kill you". My preference would be to leave it in, but if others at an FAC (or this talk page) prefer it cut, that's ok; this is not a hill I need to die on.
  • I was a bit surprised that there wasn't information about risk factors in the cause section. I see you covered this in epidemiology. I trust your judgement on this, but took me a while to find the information. Both cause and pathophysiology focus a lot on the mutations. Can we say more about other processes? For instance, in lung cancer, you talk about how tumors cause blood vessel growth to be stimulated.
    • Fair. There's not always a clear distinction between epidemiological association and cause-related risk factor. Most of the sources I used here classified the information as "Epidemiology" (which you can see by glancing through the titles of the referenced articles and cited sections) so I mirrored that here. I see it's flipped at lung cancer. Can't recall if I was following the sources there, respecting a division that predated my involvement, or if it's arbitrary.
    • As to the second part of your question, let me look into it. There's probably source material to support a few broader framing sentences like at the lung cancer article. Might help a reader make slightly more sense of the gene mutation alphabet soup.
  • though incidence is increasing in these regions at among the fastest rates in the world --> bit awkward, maybe more concise like "though incidence is increasing fast in these regions"?
    • Changed to a variation of your suggestion.
  • Together known gene --> Together, known gene
    • Done.
  • cruciferous --> gloss
    • Any suggestions? "Leafy greens" isn't a perfect overlap. Apparently "brassicas" only refers to a subset. Adding (a family of vegetables) doesn't seem to lend much meaning.
      • Given one or two examples might be easiest?
        • Done.
  • genistein --> explain
    • Done (found in soy).

—Femke 🐦 (talk) 20:35, 7 March 2024 (UTC)

History - Research

  • The history section has a surprising number of jargon: histologically, urethra, transcretal.
    • Changed histologically, but I'm not sure I've captured the distinction between the two cases. In 1817 Langstaff pulled a hard lump of tissue out of a dead man's prostate and wrote "ah, a tumor, curious". In 1853 Adams pulled a hard lump of tissue out of a dead man's prostate. He had it sliced, stained, and examined by an expert, who confirmed that the lump was indeed cancerous. Some sources credit only Adams. Others mention both. Explaining here with the hope that you might have a suggestion for clear wording.
      • Is it possible you forgot to click publish here? —Femke 🐦 (talk) 19:51, 14 March 2024 (UTC)
        • Er yes *facepalm*. Lord knows where that browser tab went. Well I've tweaked the wording again. Even published it this time. Hopefully the distinction between Langstaff's and Adams' tumors isn't too opaque.
    • Transrectal ultrasound (was a typo, sorry) and urethra are wikilinked at earlier mention. Do you think another WL is merited? Replacing the words is challenging.
      • Transrectal is certainly more understandable than transcretal, so wikilink is fine. I am a fan of the new rule of wikilinking jargon once per section. I find urethra still difficult to understand. I see it's explained once in an image, but that's all the way up in signs and symptoms. Perhaps explaining it the second time it's used in the text (first time is under image) might help? And then wikilink in history? —Femke 🐦 (talk) 19:51, 14 March 2024 (UTC)
  • I'm always surprised to see all discovering made in the English-speaking world. Couldn't find a contradiction on dewiki/frwiki, so I'm going to assume this isn't just English-speaking sources unaware of the rest of the world.
    • True, it is suspicious.
  • Continuing on the above, I was surprised to see prostate cancer underfunded compared to cancer's average given that it's a) not a disease for which lifestyle is typically blamed like lung cancer and b) it's a disease that affects men, which the NIH typically overfunds: [33]. Sources are not consistent in saying prostate cancer is underfunded either: a 2021 paper describes it as the most funded cancer, which I can't reconcile with the NIH numbers. Part of the explanation probably lies in the fact that "overall cancer" also contains general funding for cancer, such as blue sky research and councelling. A 2023 paper describes prostate cancer as middle-of-the-road in terms of funding (rank 9 out of 18 per DALY, 10 out of 18 per death, Table 2). This paper also explains that 29.2% of cancer research goes into general research, which may explain much of the discrepancy between the 11,000 and the 5,700 per death. I don't think the comparison with cancer as a whole works therefore. In the paper you cite about non-profits being underfunded, prostate cancer is just below the average line too (Figure 1b, 1c). —Femke 🐦 (talk) 09:15, 9 March 2024 (UTC)
    • Thank you for looking into this! Will follow-up when I have a moment and make some changes.
    • Ok, Mirin (2021) says A recent study of the funding of 18 different types of cancers [found women-specific cancers rank poorly] in funding normalized to years of life lost, whereas prostate cancer ranked 1st. cites Spencer, et al. (2019). There the authors use NIH data up to 2014 to track funding vs. lethality trends. They say From 2007 to 2011, prostate cancer had the highest Funding to Lethality scores of all the cancers evaluated, while from 2012 to 2014, breast cancer had the highest scores. and have a neat graph (Fig. 1) showing this trend. So Mirin seems to be (accidentally?) only referring to Spencer, et al.'s data for 2007-2011. Perhaps prostate cancer's funding vs. lethality continued to fall after 2014. I have no intuition for why that would be, and I was probably too hasty writing the summary here (I had just been at lung cancer and probably adapted this without sufficient thought). The 2023 Lancet Oncology paper you linked above is great! I hadn't seen that before. I think that's the most solid basis for the section going forward. I've rewritten that paragraph to highlight a couple of numbers from the 2023 paper. Happy to hear thoughts/criticism. Ajpolino (talk) 19:58, 18 March 2024 (UTC)

Overall, I think the article is very close to meeting the FA criteria, and I will support a nomination there after the comments above are addressed :). —Femke 🐦 (talk) 16:09, 9 March 2024 (UTC)

Thanks very much for your time and effort. I've taken a swing at most of your comments. I have a few left to get to. Feel free to follow-up on anything you feel I've insufficiently resolved. Pardon my slowness this week. Just happened to catch me at a busy moment in real life. It should be letting up shortly. Ajpolino (talk) 20:36, 12 March 2024 (UTC)
Alright Femke I believe I've hit on all your points above. Please feel free to direct me to any outstanding deficiencies you see. Thanks again for your thoughtful feedback; the article is much improved for your efforts. Ajpolino (talk) 00:41, 20 March 2024 (UTC)
I'm very happy with how everything turned out! Learned a lot from the review, not only about prostate cancer, but also more generally about writing medical articles to FA, which will come in handy in the work on ME/CFS we're planning. —Femke 🐦 (talk) 19:45, 20 March 2024 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Pre-FAC reviews

SandyGeorgia

Signs and symptoms

  • The sentence about erectile dysfunction seems out of place, or maybe just oddly worded, as relates to "Signs and symptoms".
    The wording here has changed a bit since July. Let me know if you still think it's clunky. Ajpolino (talk) 22:22, 27 November 2023 (UTC)
  • The next sentence, about prostate enlargement, jumps out also ... checking prostate size is part of routine physical exam for men, so some introduction on that ? Not sure those two sentences are sufficiently merged for flow to rest of para.
    Agreed this doesn't flow very well. I'd like to include this info as helpful context (i.e. tumors can disrupt urinary function, but a man who starts having issues urinating and reads this article should understand that his issues aren't particularly likely to be due to a tumor). Any suggestions on a better flow? I'm open to cutting the material if you think it's unneeded. Ajpolino (talk) 22:22, 27 November 2023 (UTC)
  • I understand it may be premature at this stage to get in to screening, but as most is asymptomatic, is most picked up on routine screening? If may be advantageous in this case to ignore MOS:MEDORDER and move screening elsewhere (up)? Else it may be hard to get flow right wrt most have no symptoms but detected with screening. SandyGeorgia (Talk) 21:19, 12 July 2023 (UTC)
    • I tried merging a couple sentences and removing the prostate enlargement bit. Hopefully that flows more smoothly. Also I flipped the section order as you suggested. That basically matches what we ended up doing at Lung cancer where we decided it flows better in this case to have all the clinical stuff together, with Causes/Pathophys after Prognosis. Any better? Ajpolino (talk) 00:15, 13 July 2023 (UTC)
      Yes, I think that organization will work much better. Much too pooped out tonight to re-read it all, but will get it on the next pass. Bst, SandyGeorgia (Talk) 00:19, 13 July 2023 (UTC)
      • Looking at this with fresh(er) eyes I've tried some more tweaks to hopefully improve the flow and clarity. Let me know if you think we're moving forwards or backwards. Ajpolino (talk) 20:55, 14 July 2023 (UTC)

Pathophysiology

  • Jargon alert: The transition from castrate-sensitive to castrate-resistant prostate cancer is also ... previously undefined terms. SandyGeorgia (Talk) 21:28, July 12, 2023 (UTC)
  • Actually, that whole para has a lot of undefined terms -- maybe reorganize flow and wikilink more? SandyGeorgia (Talk) 21:30, July 12, 2023 (UTC)

Screening

  • It's going to be hard to get the flow right here ... "however, detection of cancer cases that would not have otherwise impacted health can cause anxiety, and lead to unneeded biopsies and treatments" ... this comes before the reader understands that most prostate cancer is not deadly, which is what is meant by "would not have otherwise impacted health" (you die with in not because of it). Not sure how to fix (same as above with symptoms), because this invokes prognosis. SandyGeorgia (Talk) 21:39, 12 July 2023 (UTC)
  • This sentence is ughy :) :). "Major national health body guidelines offer differing recommendations, though no major health body currently recommends population-wide prostate cancer screening." Again, we need to first introduce the notion that most prostate cancer is not deadly for this to make sense. MOS:CURRENT needs fixing. And "health body" throws the reader, as in the physical body rather than health organizations. "No major health organization recommends population-wide prostate cancer screening as of xxxx, and major organizations offer differing recommendations" maybe? Somehow, before both of these sentences, the overall concept that most isn't deadly and doesn't require treatment needs to be first introduced. SandyGeorgia (Talk) 21:39, 12 July 2023 (UTC)
    Colin talked me into dropping the worst parts of that paragraph, though I'm still thinking about how to raise the issue about prognosis. Ajpolino (talk) 22:22, 27 November 2023 (UTC)
  • We skip right over digital rectal exam in screening ... if the prostate is enlarged, it can explain elevated PSA; if prostate is not enlarged, elevated PSA should be investigated ?? [34] Again, flow is difficult here ... digital rectal exam is mentioned in diagnosis, but is part of screening. SandyGeorgia (Talk) 21:55, 12 July 2023 (UTC)
  • Many national health bodies --> Many national health organizations?
  • Both recommend against PSA screening after age 70 ... can you find a source to explain that this is because, by that age, it's not going to be what you die from so risk outweighs benefit? SandyGeorgia (Talk) 21:51, 12 July 2023 (UTC)
    I've dialed this paragraph back to a more summary style, so this is no longer covered (but could be, if you insist). Ajpolino (talk) 22:22, 27 November 2023 (UTC)
  • For remaining lifespan, would we link life expectancy, or something else? SandyGeorgia (Talk) 21:51, 12 July 2023 (UTC)
I've done some tweaking to hopefully make the section clearer to the reader. Let me know if you think we're improving here.
I struggled with how/where to describe digital rectal exams. Most sources I found/used describe them separately from screening, and I've mirrored that here. In a way they're more controversial than the PSA test -- the big screening trials didn't include DREs, USPSTF still recommends against them for prostate cancer screening, American Urological Association says "As a primary screening test, there is no evidence that DRE is beneficial, but DRE in men referred for an elevated PSA may be a useful secondary test", et al. That said I agree the old wording didn't make clear that the PSA test indicates prostate size rather than just cancer. I added a bit of wording to clarify that (I hope). Happy to add more, or swap things around if you still think it's not coming across clearly. Ajpolino (talk) 22:27, 14 July 2023 (UTC)
Here's what I'm trying to get at, strictly based on our personal experience, and I trust you to reflect the sources if you can find anything :) My husband had a PSA that was doubling every year. His physician ignored it because ... USPSTF. And me concurring based on bad information from ... ta da ... Wikipedia :) In the absence of an enlarged prostate, a PSA doubling every year for three exams should be investigated even if the PSA is still not at alarming levels. When he got to an NCCN urologist, after PSA went to 12, he said that since the DRE exam showed no other reason for growing PSA (eg, no enlarged prostate), then he certainly should have been looked at more closely and sooner. So, as you have now in the article -- the DRE gives good useful secondary information, to be weighted along with the PSA values if they are growing (assuming one has a baseline, which if USPSTF has its way, one doesn't). If you can find anything on that, grand :) What the urologist said, that the GP ignored, is that the normal DRE should have been an indication that the escalating PSA was an issue, before it got to 12 (back when it was doubling from 1 to 2, then 2 to 4, then 4 to 8 ... ) SandyGeorgia (Talk) 22:52, 15 July 2023 (UTC)
PS, I'm poking around to see if I still have Walsh's (Johns Hopkins) book, but I think I put it in storage or gave it to a charity book sale ... is it worth it for me to keep looking ? [35] SandyGeorgia (Talk) 22:55, 15 July 2023 (UTC)
Okay, that's helpful to hear. The sources tend to cover a situation like his by emphasizing that increasing PSA levels merit further investigation, and the rate of increase correlates with risk. But your urologists explanation makes a bucket of sense. Let me take another look through everything tomorrow with your experience in mind and I'm sure that'll help me interpret and write things more clearly.
Regarding the Walsh's book, I've actually not read it. I see my local library has a copy. I'll put a hold on it and will be able to take a look soon(ish). Ajpolino (talk) 02:46, 16 July 2023 (UTC)
One reason I ask is there's another bit we learned that I can't completely recall how to explain ... related to a surgery that avoids taking a nerve that surrounds the prostate, and when that is possible, leaves less lasting side effects than taking everything. Or something. And that's all I can remember :) Since, when looking at life expectancy charts, we ended up going for radiation anyway ... SandyGeorgia (Talk) 03:11, 16 July 2023 (UTC)

Diagnosis

  • As mentioned above, this seems backwards, and should be part of screening ... Men suspected of having prostate cancer may undergo several tests to help assess the prostate. One common procedure is the digital rectal examination, in which a doctor inserts a lubricated finger into the rectum to feel the nearby prostate. If DRE shows enlarged prostate, could explain elevated PSA ... routine part of screening ... SandyGeorgia (Talk) 21:58, 12 July 2023 (UTC)
  • Do we need all of this ? A diagnosis of prostate cancer requires a biopsy of the prostate be taken and examined under a microscope by a pathologist. Can we just say it requires a biopsy of the prostate? The rest is obvious? SandyGeorgia (Talk) 22:00, 12 July 2023 (UTC)
    Yep, redundant, repeated a few sentences later. :) Biopsies are examined under a microscope by a pathologist, who determines the type and extent of cancerous cells present. SandyGeorgia (Talk) 22:02, 12 July 2023 (UTC)
    Removed! Not sure how I missed that. Ajpolino (talk) 22:43, 15 July 2023 (UTC)

Management

  • I know what this means, but the average reader is going to stumble: Various risk-calculating algorithms have been designed that attempt to predict a person with prostate cancer's risk of disease progression based on their clinical characteristics and test results. SandyGeorgia (Talk) 22:28, 12 July 2023 (UTC)
    Trimmed. After reformulating this a few times, I think it's actually not that critical for the reader. I've trimmed that paragraph. Hopefully it flows a bit easier now. Ajpolino (talk) 20:53, 29 November 2023 (UTC)
  • Ajpolino, can you double check this? Radiotherapy is typically given in several treatments over the course of eight to nine weeks. A shorter therapy might be recommended depending on life expectancy tables. And more generally, life expectancy is a factor in the decision between prostatectomy and radiation, as well as how much radiation. No reason to overkill if you have lowered life expectancy for other reasons. SandyGeorgia (Talk) 22:36, 12 July 2023 (UTC)
    Softened, though I didn't take the time/space to explain the life expectance connection. If on reread you think I ought to, let me know. Ajpolino (talk) 19:00, 6 December 2023 (UTC)
  • Successful radiotherapy causes a drop in PSA levels due to destruction of the tumor, while prostatectomy causes PSA to drop to undetectable levels. After radiation, drop in PSA occurs gradually over time (may be several years), while prostatectomy should be more immediate, and if it's not, some tumor was missed. SandyGeorgia (Talk) 22:41, 12 July 2023 (UTC)
    Clarified. Ajpolino (talk) 19:00, 6 December 2023 (UTC)
  • Up to half of those treated will eventually have a rise in PSA levels ... We were told in 2018 a rise in PSA is considered a recurrence of the cancer it it goes by up 2.0 or more after reaching low point ... SandyGeorgia (Talk) 22:43, 12 July 2023 (UTC)
  • For those with metastatic disease, the standard of care is androgen deprivation therapy, drugs that reduce levels of androgens (male sex hormones) that prostate cells require in order to ... Androgen deprivation therapy is mentioned in previous section, should be defined first there ... SandyGeorgia (Talk) 22:45, 12 July 2023 (UTC)
    Removed previous mention. Ajpolino (talk) 19:03, 6 December 2023 (UTC)
  • Despite reduced testosterone levels, eventually nearly all prostate cancers continue to grow ... Is there a missing word here ? Despite reduced testosterone levels, eventually nearly all metastatic prostate cancers continue to grow ???? SandyGeorgia (Talk) 22:46, 12 July 2023 (UTC)
    Clarified. Ajpolino (talk) 19:00, 6 December 2023 (UTC)
  • Ah ha ... this is defined here, but it was used earlier in the article: 2] This is the most advanced stage of the disease, called castration-resistant prostate cancer SandyGeorgia (Talk) 22:47, 12 July 2023 (UTC)
    Can't find this, so hopefully it was resolved during some other reorg. If I'm missing it please let me know. Ajpolino (talk) 19:03, 6 December 2023 (UTC)
  • I am unsure if the article is BrEng or AmEng. I changed an ise to ize, but now I see this ... interventions such as psychoeducation and cognitive behavioural therapy. SandyGeorgia (Talk) 22:54, 12 July 2023 (UTC)
    Americanized. I always have trouble seeing these, but I think I've caught them now... Ajpolino (talk) 19:00, 6 December 2023 (UTC)

Epidemiology (2)

  • Australia, Europe, North America, New Zealand, and parts of South America have the highest incidence. I frequently saw one in six for US in 2018 (rather than the one in eight now stated here); can we get some ranges on regions to show the variance? SandyGeorgia (Talk) 23:00, 12 July 2023 (UTC)
    1 in 8 appears to be the new number everyone quotes. Incidence varies dramatically by region, but I've chosen not to discuss it because it's a bit confusing. A map of prostate cancer incidence is largely a map of regional healthcare systems' wealth (i.e. in relatively wealthy places more people are diagnosed with prostate cancer), with a boost to regions that have high proportions of people with African ancestry. You can get a sense of that with the bar chart at the top of this paper. Prostate cancer deaths are a bit less susceptible to this (again, take a peek at that bar chart) but are probably still underreported in places with fewer resources. Basically I think breaking this down in an informative way needs quite a bit of space, for relatively low payout. The main message I want readers to understand on the topic is that prostate cancer is very common in all men as they age. If I were to ever write-up a Prostate cancer epidemiology article, this would certainly be a worthy topic of exploration there! Ajpolino (talk) 19:25, 6 December 2023 (UTC)
  • Increased risk also runs in some ethnic groups, with African-American men at particularly high risk – having prostate cancer at higher rates, and having more-aggressive prostate cancers.[88] I thought that, because of this, screening recommendations were different for African-American men ?? That's not in the article, perhaps it has changed? SandyGeorgia (Talk) 23:02, 12 July 2023 (UTC)
    Still mostly the case – AUA recommends screening 5 years earlier in African-American men; USPSTF provides no specific recommendation. In the 5 months since you left this comment, I've reorganized and streamlined the screening section quite a bit. I no longer summarize the slightly different age groups each national health body recommends screening. Happy to talk more about what should(n't) be covered. Ajpolino (talk) 19:25, 6 December 2023 (UTC)

Research

Lead

The lead is a bit rough and perhaps too long, and there is some underlinking in the article, but these can be revisited after others have been through. That's enough for me for now. After Colin or Spicy have been through, you might want to also ping Johnbod. SandyGeorgia (Talk) 23:20, 12 July 2023 (UTC)

Ajpolino, I haven't been able to catch up here because of two funerals ... I may not be able to weigh in until after Christmas, but I do plan to ... Bst, SandyGeorgia (Talk) 18:47, 14 December 2023 (UTC)
Take your time SandyGeorgia. This can always wait. Let me know if there's anything I can take off your plate here on WP. Otherwise, sending warm wishes as you navigate challenging times. Ajpolino (talk) 19:58, 14 December 2023 (UTC)
Thank you, Ajpolino; kind thoughts help in difficult times. I only had time ot glance quickly at the lead, and wonder if you have yet worked on it? There seems to be a bit too much emphasis on the least likely scenarios. For example, in the first paragraph of the lead, we have "Some tumors eventually spread to other areas of the body, particularly the bones and lymph nodes. There, tumors cause severe bone pain, leg weakness or paralysis, and eventually death." I suspect you haven't yet tackled the lead, but when you do, it may need re-orientation to reflect the more likely outcomes, with less emphasis on the catastrophic. Or the old adage, "most men die with prostrate cancer, not because of it". I hope to have some time after Christmas, and before the two January funerals, to be able to catch up here. SandyGeorgia (Talk) 13:37, 17 December 2023 (UTC)
Hm. I see your concern about emphasis. I had already reworked the lead, but I'd mostly summarized the sections in the order they appear – apparently not a surefire recipe for an artful lead. I've tried some rearranging to have the clinical information flow more chronologically, which hopefully puts the emphasis closer to where it belongs. Let me know if we're moving forward or backward. Ajpolino (talk) 20:38, 19 December 2023 (UTC)

Colin

Sorry I haven't done much. Sat down to look at it yesterday and then got dragged away. I realise the prostate cancer screening stuff is controversial. When I read the lead "Most cases of prostate cancer are detected by prostate cancer screening programs" I thought, well that's not true in the UK. We don't have a prostate cancer screening program. So none of our prostate cancer is diagnosed through a screening program. You have to actually visit your GP, be aged over 50, have read and discussed the pros and cons and decided it is still for you, and then the GP can request/do it. They don't advertise it or encourage it. I don't know what portion wait for symptoms before going.

I'm back, and easing back into this... "programs" was a poor choice of words. Your description mirrors the situation in the US exactly (... except for the recommendation starting at age 55). I've tweaked the wording of the lead, but I may have mangled the sentence. If you have suggested wording I'm happy to hear it. Otherwise I'll revisit in a few days once I've knocked some of my rust off. Ajpolino (talk) 20:09, 11 September 2023 (UTC)

Also, if screening is about checking people with no symptoms, otherwise healthy, how does that fit in with the symptoms overlapping with enlarged prostate. If you go to your GP with urination problems age 60, say, you might end up going down the path of these tests. But then isn't it just plain old "diagnosis" rather than screening? And an enlarged prostate is common. So how do we separate screening from diagnosis?

Agreed, it's a fine line, and the difference is somewhat arbitrary. I split out "screening" as a section here because sources tend to discuss it this way, with "screening" referring to PSA tests and occasionally the digital rectal exam, and "diagnosis" referring to "what we do next to folks who have high PSA values". Ajpolino (talk) 20:09, 11 September 2023 (UTC)

Another UK difference I spotted was that the article referred to "African-American men". But the UK NHS talks about increased risk to "black" men (and lower risk for "Asian" men). Bear in mind "black" and "Asian" in the NHS page might be reflecting the black and Asian populations that live in the UK rather than globally (but might not, it doesn't give a source). Anyway, few black people in the UK are "African-American", nor are they in Europe, or .... in Africa. So I think that needs sorted to be a bit more globally-minded wrt point-of-view.

Most sources say "African-American", though possibly just because the writer is American. Putting this at the top my to-do list. Ajpolino (talk) 20:09, 11 September 2023 (UTC)
Looked into this more and found a review that directly addresses the topic. Updated to what I believe is the mainstream view (men with "African or African Caribbean ancestry" are at increased risk) and added the review as a ref. Ajpolino (talk) 00:48, 27 September 2023 (UTC)

In the body section on screening, it leads with "Many national health bodies recommend prostate cancer screening in men aged at least 40..." But then when you look at the specifics, 40 is a really really low level, typically for exceptional sub-groups rather than everyone, and so that doesn't fit with "many". That sentence doesn't have its own source citation so not sure if it comes from the same place as the following sentence, or is unsourced. I think to be honest, the general statement would be that there is no agreement on what age, if any, to start a screening program. Since we have our own article on this, I think the reader isn't served by having a random selection of organisations and ages, at least not in prose format. I think for here we need a summary and from a source that does summarise the global (or at least Western) approaches. That summary might be to say there is a wide variation of opinion. -- Colin°Talk 08:28, 20 July 2023 (UTC)

Good point, I've had a go at trimming this back. Ajpolino (talk) 19:37, 27 September 2023 (UTC)

The staging text says "Prostate cancer is typically staged using the American Joint Committee on Cancer's (AJCC) three-component TNM system," But when I read TNM staging system it says it is maintained by the Union for International Cancer Control and describes a relationship with AJCC (different publications and slight difference in naming). So is our text a bit US focused and the TNM system is really an international one, and when the UK paragraph compares to "AJCC stage I" should it really by "UICC stage I"? -- Colin°Talk 17:01, 20 July 2023 (UTC)

Best I can tell, AJCC and UICC are supposed to be giving us unified TNM systems, but instead their systems differ slightly for some diseases (differences reviewed for urological cancers including prostate here). For prostate cancer Brits and Americans alike seem to be citing the AJCC's 8th edition manual. Even in the Cancer Research UK site if you scroll down to references you can see they reference the American version. I'm not sure if this preference is just because the AJCC manual came out more recently (2018) than the UICC one (2016) or if it's because of the differences mentioned in that review above. But if I can sort out why I'll add context if helpful. Ajpolino (talk) 19:11, 17 October 2023 (UTC)

The "Radical prostatectomy" paragraph describes four approaches. But the first two identify the location (above penis, below scrotum) and the latter two identify the instruments (Laparoscopy / Robots). Presumably the first two locations are big standard surgical approaches, though I can't see how you'd get a big hole in the area below the scrotum! It isn't clearly to me why the instrument methods shouldn't have the location of the incision mentioned or why either of the previous two locations wouldn't be used for them. I'm no surgeon. -- Colin°Talk 17:09, 20 July 2023 (UTC)

Found another review on the topic and updated the text to clarify. Apparently it's robot-assisted surgery for those who can afford it. In countries that can't afford the equipment, you'll get open surgery or a "traditional" laparoscopic approach (hand tools and a camera working through small holes in your abdomen) which is just as good for your cancer, but will leave you in bed a bit longer. Ajpolino (talk) 19:12, 19 October 2023 (UTC)
It'll take me a few days to find some time for this, just dropping by to say thank you (and SG above) for your feedback so far! The article will be much-improved for it. Ajpolino (talk) 16:37, 21 July 2023 (UTC)
Popping by to say I'm not dead, just away for regular life reasons. Still planning/hoping to return to this shortly. Hope all are well. Ajpolino (talk) 03:44, 22 August 2023 (UTC)
No problem. There's no rush. But I'm glad you are not dead. :-). -- Colin°Talk 07:26, 22 August 2023 (UTC)

Graham Beards

I have a few comments which I'll list here.

  • Perhaps the first sentence of Signs and Symptoms belongs at the start of the next section?
  • In Screening, is "typically" redundant? And there's a possible problem with "person" since those with vaginas don't have a prostate gland (they have Skene's glands and we have "men" under diagnosis).
  • The >3ng versus >4ng is confusing specifically where it says for >3ng " 10% a high-grade cancer that requires treatment" but for >4ng it says "are often referred for a prostate biopsy". It sounds like it's a better prognosis to have a level >4ng.
  • I think we need more on the PSA subtypes, particularly about PCA3 (and those red links are not helpful).
  • "Epithelial cell and transitional cell both redirect to epithelium, so the links aren't perfect for the lay reader.
  • "Active surveillance" is defined twice, one short and one long. Is there a way around this?

I have made few small edits regarding missing articles and fused participles That's all for now. Graham Beards (talk) 13:38, 11 December 2023 (UTC)

Made changes for your first 4 comments, let me know what you think. For #4 (PSA subtypes) I've tried to give the reader a brief sense of the post-PSA secondary testing world without too much jargon, and without getting into detail that's undue for an article on prostate cancer. I'm concerned I've left it either too detailed or not detailed enough. Would appreciate your thoughts. Will hit your last two bullet points, hopefully today. Ajpolino (talk) 15:49, 13 December 2023 (UTC)
To your last point, that first paragraph is my attempt to orient the reader with a quick summary intro. Since it's a summary, it's necessarily a bit repetitive. I think I've read the section too many times to see it clearly. A couple obvious options, I'd be happy to hear which you think is best: (1) Remove that paragraph altogether, (2) Keep it mostly as-is but remove the repeated definition of "active surveillance" (could be as simple as ... monitored regularly by active surveillance – repeat testing for a worsening of their disease), (3) Reducing repetition with some intervention between #1 and #2 in scope, (4) leave it as-is.
I've fiddled with a few variants of #2, but honestly I find myself now leaning towards #1. Wondering if you think the summary paragraph at the top is valuable orientation for the reader. Ajpolino (talk) 15:43, 14 December 2023 (UTC)
I think #2 is better. Graham Beards (talk) 17:20, 14 December 2023 (UTC)

Hi Colin and Graham Beards, I believe I've made it through your last round of comments. If you've got time, I'd be happy to hear any other comments/concerns you may have. Thank you for your feedback so far. I hope you both had restful holidays. Ajpolino (talk) 16:01, 3 January 2024 (UTC)

Happy New Year to you. I will try to get around to looking at this. -- Colin°Talk 18:15, 3 January 2024 (UTC)
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