Talk:Prostate cancer

Pre-FAC reviews

SandyGeorgia

• Avoid placing images at ends of sections, MOS:ACCIM-- there are several, and some sandwiching, but I'm unsure to where to move these images. SandyGeorgia (Talk) 20:57, 12 July 2023 (UTC)
• Infobox, is there another kind of surgery than prostatectomy ... should that be added and linked instead of just saying "surgery"? Treatment: Active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy SandyGeorgia (Talk) 21:00, 12 July 2023 (UTC)

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)
  • Solved if we stick with the new organization. Ajpolino (talk) 00:16, 13 July 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 ?? [1] 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 ? [2] 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

• Lung ??? but prostate cancer nonprofits have lower revenue than would be expected for the number of lung cancer cases, deaths, and potential years of life lost. SandyGeorgia (Talk) 23:12, 12 July 2023 (UTC)
  • Typo. Fixed. Ajpolino (talk) 21:23, 16 July 2023 (UTC)

External links

• Do we really need the Mayo video? Pretty much every NCCN Urology department has one ... SandyGeorgia (Talk) 23:48, 12 July 2023 (UTC)

  No opinion on any of the external links. I've just left them in place since I got here. Feel free to remove or replace them with something more useful. Ajpolino (talk) 21:44, 16 July 2023 (UTC)

  Gone now. Ajpolino (talk) 19:25, 6 December 2023 (UTC)

Lead

• ah ha ...we do have this in the lead, but it the flow/organization issues in the body (described above) need to account for this. Most prostate cancers are slow growing and will never cause illness or death. SandyGeorgia (Talk) 23:18, 12 July 2023 (UTC)
• A bit confusing, contradictory, since not recommended at advanced age ... Most national health bodies recommend regular prostate cancer screening for older men who are well-informed of the risks of screening.. SandyGeorgia (Talk) 23:18, 12 July 2023 (UTC)

  Removed (along with reorganization and trimming of this material, per Colin's suggestion below). Ajpolino (talk) 20:29, 21 November 2023 (UTC)

• A definitive diagnosis requires a biopsy of the prostate. A sample of the suspected tumor is examined by a pathologist under a microscope. --> The second sentence adds nothing. SandyGeorgia (Talk) 23:18, 12 July 2023 (UTC)

  Removed. Ajpolino (talk) 20:29, 21 November 2023 (UTC)

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)

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

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.

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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)
      • Fair, removed for now (possibly for good). Ajpolino (talk) 20:01, 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).
    • Perfect. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• 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.
    • This is exactly what I had in mind! —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• 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'm happy to go with your preference here. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• 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.
    • Added a couple of sentences. Ajpolino (talk) 00:41, 20 March 2024 (UTC)
• 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 gave it a parenthetical explanation at first use, and wikilinked it here. Let me know if there's other jargon you'd like evened out. Ajpolino (talk) 21:22, 15 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: [3]. 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.

Did you know nomination

The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: promoted by AirshipJungleman29 talk 19:57, 12 April 2024 (UTC)

(

• Comment or view
• Article history

)

• ... that in a year, 1.2 million people get diagnosed with prostate cancer, and over 350,000 people die from it? Source: Rebello RJ, Oing C, Knudsen KE, Loeb S, Johnson DC, Reiter RE, Gillessen S, Van der Kwast T, Bristow RG (February 2021). "Prostate cancer". Nat Rev Dis Primers. 7 (1): 9. doi:10.1038/s41572-020-00243-0. PMID 33542230. S2CID 231794303.
  • Reviewed: QPQ not required, only one previous nom.

Improved to Good Article status by Ajpolino (talk).

Number of QPQs required: 0. Nominator has less than 5 past nominations.

Post-promotion hook changes will be logged on the talk page; consider watching the nomination until the hook appears on the Main Page.

Mugtheboss (talk) 12:16, 23 March 2024 (UTC).

General eligibility:

• New enough:
• Long enough:
• Other problems:

Policy compliance:

• Adequate sourcing:
• Neutral:
• Free of copyright violations, plagiarism, and close paraphrasing:
• Other problems:

Hook eligibility:

• Cited:
• Interesting:
• Other problems:

QPQ: None required.

Overall: No images, QPQ also unnecessary. Claim is properly cited, and mentioned multiple times throughout the article. No copy-vio issues upon spotchecks and the source is reliable. Article was recently promoted to GA after a lengthy review, so congratulation are in order for that.

The source's quote is specifically In addition, more than 1.2 million new cases are diagnosed and global prostate cancer-related deaths exceed 350,000 annually, making it one of the leading causes of cancer-associated death in men

I could maybe see a close paraphrasing issue here but I'll chalk it up to WP:LIMITED since these are simple facts that are hard to reword. I made a few minor tweaks to the lead and to the article to massage out an inconsistency, please review here: [4]. Passing DYK, congrats!! 🏵️Etrius ( Us) 00:45, 25 March 2024 (UTC)

Thank you for the swift review, this nom passed through much faster than my last.

Fun fact: I actually came up with the current hook early on in the GAN process after seeing the diagnosis and death rate in the infobox, without even seeing the actual paragraph until after the article was promoted to GA. — Mugtheboss (talk) 20:22, 25 March 2024 (UTC)

More comments from Colin

• "Prostate tumors were initially thought to be rare and an 1893 report described just 50 cases in the medical literature."

This comes out of the blue to the reader. Where does "initially" fit in the thousands of years of human experience? We don't get a sense here that prostate tumors were only discovered in the 19th century and it is one of those doctors who believed the condition was “a very rare disease” (see source). I think details of the 1893 report aren't warranted in the lead. How about "Prostate tumors were first identified in the 19th century and then considered to be very rare". In the body it says "The disease was initially thought to be uncommon" which suggests this is a widely held view, but the source only really attributes that opinion to Adams. It might be fine to be vague in the lead (unless you can find a way to be specific) but in the body I think we should similarly attribute that view to Adams.

Hmm. I've fiddled with the lead wording a bit. Let me know if we're getting better or worse. Turning my attention to the History section presently. Ajpolino (talk) 01:18, 23 April 2024 (UTC)

Fiddled with the History section wording a bit as well. You should be able to see the relevant page of the source as a preview if we don't have access through TWL. Ajpolino (talk) 01:24, 23 April 2024 (UTC)

• "MRI results can help distinguish men who have real tumors (and therefore are recommended for biopsies) from those who do not (and are spared biopsies)"

This is a rather passive sentence with two parentheticals. I don't really like the words "real tumors" as though the others were imaginary. Presumably the alternative is enlargement/hardening without a tumor cause (after a digital exam) or high PSA without a tumor cause. I see that high PSA can lead to an MRI (but only recommended, which suggest not always done) which leads to a biopsy. But where does the digital exam fit in this, other than being common? What is the "Men suspected of having prostate cancer" reason? Is that always a high PSA or can it be a concern about urination and a digital exam or something else? The parathesis says "spared biopies" which suggests this is something unpleasant or hazardous. And the description doesn't sound like fun, but can we be explicit about this?

"real tumors" - Good point. Bad wording. I've changed it up a bit.

Most of the time, "Men suspected of having prostate cancer" have high PSA. DRE has become controversial, as there's some evidence it doesn't improve diagnostics over PSA alone. Some large organizations have dropped it from their recommended diagnosis path; some have not. I didn't think a discussion of that was due, so I tried to glide through it. Recommended or not, DREs are still very common. Men with enlargement/hardening but low PSA could still be "suspected of having prostate cancer" and referred for a biopsy. I suspect that DREs are on their way out, and in ten years or so it'll be dropped from the mainstream (and from this article). But as of now, I'm not sure I've nailed the coverage/wording exactly right. Ajpolino (talk) 14:08, 23 April 2024 (UTC)

• "This is typically done by robot-assisted surgery" The source says "In 2020, RARP has almost completely replaced laparoscopy for radical prostatectomy, except in countries where robotic machines are not affordable owing to the high initial costs of ~US$2.5 million" That's not a small amount of money and the source's source PMID 25535000 isn't particularly glowing about the benefits and since it was dated 2015 isn't actually a source for the 2020 figure. We don't describe any negatives (other than initial cost) but that article does, both medical and ongoing cost. Perhaps we have a better recent source that fairly describes the pros and cons. Either way, I think the sentence should lead with something like "In countries that can afford the considerable increased costs, this is typically done by robot-assisted surgery". There seem to be various opinions of how much the robot-assisted surgery has replaced the other, so perhaps it isn't just down to unavailability due to cost. " -- Colin°^Talk 12:21, 21 April 2024 (UTC)
  • Changed to "In wealthier countries, this is typically done by..." Ajpolino (talk) 14:13, 23 April 2024 (UTC)

Thank you for taking a look! Should be able to get to the other two items some time tomorrow. Of course, feel free to add more if you see other things that could use ironing out. Ajpolino (talk) 01:26, 23 April 2024 (UTC)