Talk:Prostate cancer

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. Sandy Georgia (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 Sandy Georgia  (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. Sandy Georgia  (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, Sandy Georgia  (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. Sandy Georgia  (Talk)  21:28, July 12, 2023 (UTC)
 * Actually, that whole para has a lot of undefined terms -- maybe reorganize flow and wikilink more? Sandy Georgia  (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.  Sandy Georgia  (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. Sandy Georgia  (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 ??  Again, flow is difficult here ... digital rectal exam is mentioned in diagnosis, but is part of screening.  Sandy Georgia  (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? Sandy Georgia (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? Sandy Georgia (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 ... ) Sandy Georgia  (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 ? Sandy Georgia  (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 ... Sandy Georgia  (Talk)  03:11, 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 ... Sandy Georgia  (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 ... Sandy Georgia (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? Sandy Georgia  (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. Sandy Georgia (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. Sandy Georgia (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. Sandy Georgia  (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. Sandy Georgia  (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 ... Sandy Georgia (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 ... Sandy Georgia (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 ???? Sandy Georgia  (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 Sandy Georgia (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.  Sandy Georgia  (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? Sandy Georgia  (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?  Sandy Georgia  (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. Sandy Georgia  (Talk)  23:12, 12 July 2023 (UTC)
 * Typo. Fixed. Ajpolino (talk) 21:23, 16 July 2023 (UTC)

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. Sandy Georgia (Talk)  23:20, 12 July 2023 (UTC)
 * 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. Sandy Georgia  (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.. Sandy Georgia (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. Sandy Georgia (Talk)  23:18, 12 July 2023 (UTC)
 * Removed. Ajpolino (talk) 20:29, 21 November 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, Sandy Georgia (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. Sandy Georgia  (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. 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)
 * 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?
 * 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 and, 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)

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 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)

Recent changes to section order, et al
Hi, I'm sorry to have reverted your recent change to the article's section order, et al. Since you've made a bunch of changes at once, it's challenging to see what they all were. This article has recently been reviewed by many eyes as part of the process to be designated a "featured article". That doesn't mean it's perfect, but does suggest perhaps we can proceed a bit more cautiously than with your average article page. Let's discuss the things you wish to change here. We can pull in others to find consensus if needed. I'll highlight the biggest changes for discussion below. Since there were so many changes across the article, I'm sure there are uncontroversial changes I missed, and for that I apologize. Ajpolino (talk) 13:02, 26 May 2024 (UTC)


 * Thank you for your kind message. I understand that it is difficult to retrace all changes at once, so let me explain my main intentions and changes:
 * Image: I changed the infobox image to a micrograph showing prostate adenocarcinoma because the previous one just shows the anatomical perspective of the prostate rather than the actual disease the article is about. Instead of the micrograph, we could use only the diagram as well to represent the topic adequately. Additionally, I adjusted a few other images to fit better within their sections visually.
 * Introduction: I shortened the introduction by removing the explanation of the prostate, as this is covered in the article "prostate." I deleted the sentence "Early prostate cancer causes no symptoms" because this is stated in the following paragraph: "Most prostate tumors remain small and cause no health problems."
 * Content order: Most disease articles on Wikipedia follow the order: symptoms, causes, pathophysiology, diagnosis, management, prevention, epidemiology, research, history (for example, see allergic rhinitis and multiple sclerosis or more specifically other oncologic diseases such as colorectal cancer or esophageal cancer). While this can vary, symptoms, causes, pathophysiology, diagnosis, and management should remain in this order. The rationale is that most diseases are characterized by symptoms. Next, there are causes and risk factors from which a disease originates. Following this is the mechanism of the disease itself, the pathophysiology, which can be determined by diagnosis. After diagnosis, the disease is treated. Before diagnosis, there are typically preventive measures, including screening, which is the technical assessment of someone's state based on the estimated risk of the person being affected by the disease. After management, a prognosis is given on the likelihood of recovery. Historical and social side facts are typically referred to last. Additionally, I moved the subtopics of epidemiology to causes as they both are formal treatises that cover epidemiological facts just briefly in the background. Technically, prevention, including screening, could be included as part of management as well.
 * I understand the idea of sorting the contents based on the experience of the patient, but I don't think it is that useful as this article is an encyclopedic article about the disease and not a how-to guide or pamphlet from a cancer support center, which is designed to accompany and inform the affected person in their recovery about their specific course of therapy. Imho, this article should not make a difference between academic and clinical information, following the alignment of most articles about diseases as in the end, cancer is just a disease—a disease requiring specialized personnel, therapy and educational work to create awareness, but still a disease—something that needs to be treated just the same way as any other disease to meet essential rules like neutrality, equality, and the principle of encyclopedic work.
 * Lastly, I just fixed some links and added them to phrases such as the "uncontrolled growth of cells" in the beginning while spacing the source code to make it more clear and uniform.
 * I hope, you can understand my rationale for the changes. If you have any additional ideas or concerns, just let me know. –Tobias (talk) 14:02, 26 May 2024 (UTC)
 * I think we're just going to have to disagree on section order. I feel the old order did a better job of introducing the article and giving it a readable flow. I'm aware that many other articles use the order you're suggesting, as it's the recommended (though not required, of course) order in MEDMOS. But I feel this order is superior for this particular topic, and is also the order that I've used at Lung cancer and Breast cancer. If anyone else is watching this page, their thoughts would certainly be welcome. If not, we can ask for more opinions at WT:MED.
 * Image - In general, I think the lead image should be understandable (even informative?) to the general reader of the article. I try to avoid histology images as lead images because I imagine they're meaningful to a very very low percentage of readers (some subset of healthcare providers and researchers?). Your idea of just using the tumor cartoon seems good to me. I can redo that and your other image moves this evening, or certainly you're welcome to do so any time.
 * Intro - That sounds good to me. Same as above, I can redo this evening or you're welcome to. Sorry for undoing the whole thing. With the section order change the diff viewer just showed the whole article as changed and I was having trouble understanding.
 * With image movements and intro wording, if there's anything else we disagree on, I'm sure it'll be small and we can discuss the particulars. Thank you for your patience, and for your interest in improving the article. Taking a quick, semi-creepy look I can see that your activity has increased substantially the last few months. I hope you decide to stick around. The medicine articles need an absolute ton of work. Medicine-interested editors are a precious resource, and I'm glad to see another one. Best, Ajpolino (talk) 19:24, 26 May 2024 (UTC)
 * I agree with Ajpolino on the image and the order; it's not strictly required to follow WP:MEDORDER, a suggested guide, and if the article flows better with a different structure, that's fine. Confident you all will work out the other matters, mindful of WP:FAOWN. Sandy Georgia  (Talk)  19:49, 26 May 2024 (UTC)
 * I'll redo those changes now as you suggested, except for the order; I'm glad we were able to reach consensus there. You're welcome to tell me if you feel unhappy with any of my redone changes once I've made them.
 * Maybe I can better understand your reasoning for the order if you explain it to me. By "superior," do you mean that the current wording of the text is adapted to this specific order and would be less effective if changed? In that case, the words could theoretically be changed easily to maintain overall consistency in the articles while still allowing for flexible order. However, this doesn’t seem that important since you're not alone in your opinion, and even the guidelines of Wikipedia usually favor keeping the initial design of articles.
 * I'll have to accept that, even though I'm always a fan of questioning the status quo and changing it if there is a promising alternative. Sometimes, I know I can be a little too enthusiastic about this :D
 * The exchange here on Wikipedia is quite nice, I haven't planned to leave anytime soon. Oh, and don't worry, I already took a little peep at your activity too - it's great seeing other editors engaged in medical topics like you are ^^ –Tobias (talk) 16:55, 27 May 2024 (UTC)
 * Oops sorry for the overlap in timing here. I believe I've just redone your image changes (except the histology image, per above), and your lead changes (except the clause at the end of the first sentence, which I think is useful context for the average reader – an unofficial survey of my non-specialist family members around me suggests that most people don't know what/where a prostate is). Ajpolino (talk) 16:56, 27 May 2024 (UTC)
 * Well then, I don't got an option to argue with that, fine by me 👀 –Tobias (talk) 17:00, 27 May 2024 (UTC)
 * Do you think we could embed 'screening' in 'prevention', or the other way around? Other ideas that come to mind are to incorporate 'special populations' into 'epidemiology' and to move the pure genetic and lifestyle information from 'epidemiology' to 'cause'. –Tobias (talk) 17:15, 27 May 2024 (UTC)
 * Nevermind, you already did. –Tobias (talk) 16:56, 27 May 2024 (UTC)
 * Perhaps instead of defending the current section order (which I do think is superior) I can reframe the distinction. The order you suggested is the generic order prescribed in MEDMOS; it's the status quo. Here, we have questioned that status quo and switched to a promising alternative that I believe improves the article's readability. It satisfies my (very small) inner iconoclast; I hope it does the same for you, when framed this way. Cheers. Ajpolino (talk) 17:01, 27 May 2024 (UTC)
 * It helps me understanding your thinking at least, thank you. –Tobias (talk) 17:19, 27 May 2024 (UTC)
 * I don't think there can be a standard order for medical conditions, since causes range from unknown to those understood in great detail, and treatments from an ensemble of options to none. The current order works Draken Bowser (talk) 20:32, 26 May 2024 (UTC)

Section order
You changed the section order, moving Causes/Pathophysiology up to sit between Signs & symptoms and Diagnosis. Screening got moved down to a subsection of Prevention. Some Risk factor-related info got moved from subsections of Epidemiology to subsections of Causes.

The rationale for the old order was that the opening six sections flowed in the order of a person's prostate cancer experience. Clinical stuff came first, then more academic stuff. Signs & symptoms > Screening (which for prostate cancer, is not a preventative, but rather something that precedes diagnosis) > Diagnosis > Management. The small Prevention section was inserted kind of randomly, and could float elsewhere. After the clinical information, the story flowed from prostate cancer's Cause > Pathophys > Epidemiology, etc. I think moving up Causes disrupts the flow of the article, as does pushing the risk factors-related info into that section. Ditto moving screening down, when it's something that readers will probably interact with in their own healthcare system and be interested in. Happy to discuss more, but I've got to step away from the computer for a few hours. Will return later. Thanks Ajpolino (talk) 13:18, 26 May 2024 (UTC)


 * Thank you for your efforts, I tried to explain my changes above. I hope you have some enjoyable hours away from the computer. –Tobias (talk) 14:04, 26 May 2024 (UTC)