Talk:Prostate cancer/Archive 3

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

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

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

Should mention bipolar androgen therapy
bipolar androgen therapy has been studied for CRPC and hormone-sensitive PC  and found worthy of further study. - Rod57 (talk) 17:15, 12 December 2016 (UTC)
 * If all we have is a pilot study, IMO no. Doc James  (talk · contribs · email) 19:50, 12 December 2016 (UTC)
 * agreed. Jytdog (talk) 19:52, 12 December 2016 (UTC)

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

The figure, 18%, is likely incorrect, though editor may have intended to say something other than what is written. The citation leads one to an abstract that doesn't back up the sentence. Badiacrushed (talk) 02:13, 11 April 2017 (UTC)
 * The information is dated so I don't object to it being removed, but the source is the the whole article, which is freely available from the pubmed abstract that was linked to, and it did roughly support those figures. I believe that the "18% affected" came from Table 10, which was actually the % of men who got prostate cancer in the period 1999-2001.   The 3% death rate came from Table 3 (~30,000 deaths for every 100,000 people) Jytdog (talk) 02:38, 11 April 2017 (UTC)
 * Currently it is 13% but that belongs under epidemiology Doc James  (talk · contribs · email) 17:39, 11 April 2017 (UTC)

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Break even point
I think there are real medical issues involved in the treatment of prostate cancer, related to PSA testing. I also think that one way to objectively state what the benefit/loss point is with PSA testing is something along the lines of stating a PSA level after which treatment is a net benefit and below which treatment is a net loss. This is a very gross kind of analysis but I think is undeniably true. If a group of people all have PSAs over 40, I dont think that there is any question that as a group they will benefit from treatment. A group of people with PSAs under 2, will certainly net suffer as a group from treatment. The switch over balance number, which no doubt not to be used as mandatory in every case, nonetheless removes the discussion from the realm "are doctors only after money" and Never get your PSA tested, into something that would be fact based, and give the very gross picture, less misleading than the current statements, although far from sufficient in any specific case. Maybe the NCCN will do something like this. ( Martin | talk • contribs 21:22, 15 June 2017 (UTC))
 * What matters is what WP:MEDRS sources say. Please be aware that this page is not for general discussion of the topic, but for improving the article. Jytdog (talk) 05:47, 16 June 2017 (UTC)

JAMA review
10.1001/jama.2017.7248 JFW &#124; T@lk  10:54, 29 June 2017 (UTC)

The View That Prostate Cancer is Mostly Chance
I put this back in, I think it is unjustified to take out this view. Firstly the references are to comments that are discussing the paper that first contends that most prostate cancers are due to chance and are not the primary paper itselft. Furthermore, this page already has many primary sources in it (eg. the entire paragraph about XMRV is just primary sources (references 45-50)). Furthermore, there are many news sources that covered this view so I think it is fair to put it in as a minority opinion. — Preceding unsigned comment added by Jb12345678910111213 (talk • contribs) 22:53, 29 June 2017 (UTC)
 * The section needs to be updated with better refs. That is not a reason to add more badly sourced content. I will make updating this based on MEDRS refs a priority - we will see what more recent reviews say on these matters.  Jytdog (talk) 03:17, 30 June 2017 (UTC)
 * This is an excellent comment on pubmed commons "The authors confuse mutation incidence with cancer incidence. Furthermore the factors are not additive. Mutations are obviously related to the number of cell divisions, which is well known, but this does not tell anything on the contribution of heredity and environment."
 * And confirms why we try to use review articles. I have moved the XMRV stuff to the research section. Doc James  (talk · contribs · email) 15:17, 30 June 2017 (UTC)
 * Anyway the paper is basically arguing that prevention is futile for most cases. This is not a main stream opinion but an interesting hypothesis requiring further analysis. Doc James  (talk · contribs · email) 15:26, 30 June 2017 (UTC)

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

When metastatic
10.1056/NEJMra1701695 JFW &#124; T@lk  12:19, 8 February 2018 (UTC)

"they still recommend against PSA screening for those who are 70 or older."
Ref says "The USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older."

Supposedly per User:QuackGuru this failed verification and they removed the reference. I have restored it. Doc James (talk · contribs · email) 03:52, 3 March 2018 (UTC)
 * That does not verify the current claim. Why did you restore it? QuackGuru ( talk ) 15:18, 3 March 2018 (UTC)

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

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


 * Any discussion of USPSTF should include the specific wording that their recommendations were flawed (d'oh-- that is why they had to back off). Because reliable sources say that, and because every urologist knows that.  There is too much black-and-white here, and incorrect decisions in this area impact men's lives. Reputable urologists knew how to screen, how to detect, and how to treat in spite of the influence the USPSTF had on general physicians without specialist knowledge.  You can find the wording in sources to make this article comprehensive-- it will not be a quick fix. Anecdote.  GP wasn't worried.  We were lucky to have a friend who worked in urology, who said, get your prostate in here now.  Urologists know.  USPSTF unduly influenced entire organizations and general physicians with faulty analysis of data, and this only happened because of changes resulting from Obamacare. Let's not have wikipedia be on the wrong side of men dying, when reliable medical sources are available.  You cannot write this article for a 12-year-old ... clarifying and expanding clauses will be needed.  You do not like to write that way, Doc, but your black-and-white, clause-free sentences will not be comprehensive, accurate, or reflect all sources.  Nuance and explanation are needed for every part of this topic.   I suggest at least keeping an open mind to the fact that many more sources saying the same things will be the trend in 2018, because the uptick in non-organ-confined prostate cancer due to the USPSTF is on the demographic horizon.  Sandy Georgia  (Talk)  17:37, 3 March 2018 (UTC)

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

The article goes on to say:

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

The text in bold supports "in some people, may lead to unnecessary disruption and possibly harmful consequences". Doc James (talk · contribs · email) 12:21, 5 March 2018 (UTC)
 * Current wording "Such screening is controversial and, in some people, may lead to unnecessary disruption and possibly harmful consequences.[89]"
 * The text contains the unsupported WP:WEASEL word "some" and the text in bold does not support "Such screening is controversial". Different sources make different claims. It will confuse our readers if sources are misplaced or do not verify claims.
 * Current wording "While USPSTF has reversed their complete opposition to PCa screening they still recommend against it for those who are 70 or older."
 * That quote does not verify "reversed their complete opposition". Verification has not been provided for "reversed their complete opposition" using the additional source. QuackGuru ( talk ) 23:42, 5 March 2018 (UTC)


 * And other sources explain that, in the US, at age 70, men still have 15 years of life expectancy, so PSA screening makes sense for healthy men. I have given you those sources, and it is possible to reflect both sides of the story.  Prostate cancer is not binary-- every case and situation is different, and we should not be trying to write a black-and-white, one-size-fits-all article, when that is not what sources do, and that is not what practitioners do.  There is an extreme over reliance on USPSTF here, to the exclusion of other sources.  It would be more expedient to stop focusing on USTFPS and start writing from broader sources.  For example (there are others):  PMID 29406053  PMID 27995937  Could you also please stop using excess markup?  Sandy Georgia  (Talk)  00:51, 6 March 2018 (UTC)
 * Yes you really like a source written by the person who has patents on the test in question. We have lots of boarders sources beyond the USPSTF like the World Cancer Report, CDC, and NCI. Doc James  (talk · contribs · email) 12:50, 6 March 2018 (UTC)

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

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

Support

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

Discussion on both sentences

 * Premature to be jumping to RFC because you are both still over focusing on one source, one issue, and not even bringing in the broader issue-- no matter what this one flawed recommendation was, others do recommend screening for 70-year-old men.  It is individual and about their overall state of health, family history, other factors.  Sandy Georgia  (Talk)  00:54, 6 March 2018 (UTC)
 * This is not about this particular recommendation. This is about verifiable content versus failed verification. I don't have a problem if the wording completely changes using a different source and so on. QuackGuru ( talk ) 01:57, 6 March 2018 (UTC)
 * Four RfCs at once is not appropriate.
 * It is also unclear what you are suggesting in this RfC.
 * Refs are supposed to go at the end of sentences or after punctuation, not in the middle of sentences. Doc James  (talk · contribs · email) 12:48, 6 March 2018 (UTC)
 * I tried to discuss this previously. See Talk:Prostate cancer.
 * Each citation is placed where they verify each individual claim. See WP:CITEFOOT and WP:INTEGRITY.
 * I clearly explained it in my edit summary on 16:22, 2 March 2018 before starting this RfC. I am unsure why the ref is being restored when it is not needed and does not verify the claim. I am proposing to remove the ref that was restored that does not verify "reversed their complete opposition". QuackGuru ( talk ) 15:32, 6 March 2018 (UTC)

Proposal to include many doctors widely rejected prostate cancer screening in Prostate cancer section
Proposed wording: "As a result of the USPSTF's previous recommendations, many doctors widely rejected prostate cancer screening, which led to a return to more occurrences of high-grade and progressed prostate cancer being diagnosed. " <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC)

Support

 * Support, as proposer. We are documenting an ongoing controversy going back many years. This is relevant and on point. <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC)

Oppose

 * Oppose Guess why proportionally more high grade tumors occur with less screening? As less screening has occurred in the United States the number of not significant prostate cancers has doped in half. That means the denominator has gotten smaller. Lets say 10 high grade occur a year out of 100 = 10% high grade. Number of cases decreases to 50 with still 10 high grade that means we see 20% high grade. You add to this the fact that the author of the article in question holds a bunch of patents on the test in question / invented the test and will financially benefit from increased use. Doc James  (talk · contribs · email) 13:01, 6 March 2018 (UTC)
 * Oppose per Doc James. Additionally screening carries risks because while a high PSA does not mean the patient has cancer — it means additional tests are needed to make sure there is not a cancer. The only test that is valid per current evidence is biopsy, with the specificity and sensitivity of MRT and PET/CT being found in 2014 to be difficult to assess (http://www.sbu.se/en/publications/sbu-assesses/diagnostic-imaging-in-the-staging-of-prostate-cancer/ ). Biopsy is associated with bleeding and a has been implicated in a number of deaths. So you have 1. risks with biopsy, 2. risks with treatment for those who would never get sick, 3. the risks of provoking fear among those with high PSA but no cancer. In the grand scheme of things it isn't relevant that more high-grade cancers are found, when the absolute number goes down.
 * To present an analogous situation, if we started screening everyone for the common cold: We would find the number of hospitalizations for post-common cold pneumonia decreased relative to the number of cases of common cold. The statement can be made to sound alarmist, when in reality it doesn't mean anything. See Screening_(medicine). Carl Fredrik  talk 16:14, 10 March 2018 (UTC)

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

The above quote verifies the following proposal: "As a result of the USPSTF's previous recommendations, many doctors widely rejected prostate cancer screening, which led to a return to more occurrences of high-grade and progressed prostate cancer being diagnosed." <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:47, 6 March 2018 (UTC)

Different sources say similar things happened as a result of USPSTF's recommendations. For example, on another page it says "The PSA screening rates have dropped as a result of the 2012 USPSTF's position." using another source. The text is being asserted as fact without including "studies indicate". There are no serious objections based on recent WP:MEDRS compliant sources. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:12, 6 March 2018 (UTC)

A 2017 review states "Editorialising in The Journal of Urology, Samir Taneja, MD, wrote: “The mass confusion regarding interpretation of guidelines and application in practice is the result of a recommendation that is not particularly intuitive. How does one prevent prostate cancer death if one is not looking for prostate cancer?”87 In response to the October 2011 draft, the AUA responded by saying “the USPSTF—by disparaging the [PSA] test—is doing a great disservice to the men worldwide who may benefit from the PSA test”88…" That's bad. I mean really bad. The review further states, "Moreover, clinicians and researchers have challenged the recommendation because the USPSTF excluded relevant data. This Wikipedia article should not exclude relevant content from the lead or body. <b style="color: #e34234;">QuackGuru</b> ( talk ) 02:54, 8 March 2018 (UTC)

A 2017 review found "The 2012 recommendation against routine PSA screening in all age groups has resulted in significant declines in PSA screening rates, with 23% to 45% of men being tested before the guideline statement compared to 17% to 35% after the guideline was published (table 1)." <b style="color: #e34234;">QuackGuru</b> ( talk ) 04:39, 8 March 2018 (UTC)

Proposal to include Canadian Urological Association recommendations in Prostate cancer section
Proposed wording: "The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making. The starting age for most people is at age 50 and age 45 among those at high risk. " <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC) (Proposal has been changed. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:26, 6 March 2018 (UTC))

Support

 * Support, as proposer. Good information for those under 50 as well as over 50. <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC)

Oppose

 * Oppose because CUA says no such thing. Doc James  (talk · contribs · email) 13:06, 6 March 2018 (UTC)
 * Oppose — you're cutting the quote short, and you're not presenting it as a quote. Carl Fredrik  talk 16:18, 10 March 2018 (UTC)
 * This proposal uses practically the same wording as User:Doc James wrote. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:18, 10 March 2018 (UTC)

Discussion on Canadian Urological Association recommendations

 * You are ignoring the bolded recommendation that they actually give which was already quoted above.  There is also no reason to especially emphasize the Canadian guideline.  This is exceptionally tendentious argumentation and weight. Jytdog (talk) 15:50, 6 March 2018 (UTC)
 * The CUA do say such things under the section Justification and they do say other things. The previous proposal and the adjusted proposal are both sourced. I am not tied to any specific wording. I removed the quote and adjusted this and other proposals. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:26, 6 March 2018 (UTC)

See Talk:Prostate cancer for overall main discussion. I think that would clear up any confusion with this and subsequent proposals. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:31, 7 March 2018 (UTC)

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

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

"

Adjustments have initially been made. This proposal and others could change in the future. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:22, 6 March 2018 (UTC)

Support

 * Support as 1st choice, as proposer. This proposal provides much more useful content than the current wording. <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC)

Oppose

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


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

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


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


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


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


 * Doc James (talk · contribs · email) 13:02, 6 March 2018 (UTC)
 * The CUA do say such things under the section Justification, but I rewording part of the proposal to move things forward. I also changed "remain" to "are". If you think the proposal could be more concise or if you have a better suggestion you can make a 3rd proposal or you can provide more feedback. The current wording in the lead provides very little information. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:26, 6 March 2018 (UTC)


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

2nd proposal to replace current wording in lead
Proposed wording: "The benefits and risks of prostate cancer screening are controversial. Prostate-specific antigen (PSA) testing has been questioned as a result of concerns regarding the risk of causing unneeded biopsies and overdiagnosis and overtreatment. The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making. The starting age for most people is at age 50 and age 45 among those at high risk.

"

I have trimmed this proposal and made it more concise than the original proposal. <b style="color: #e34234;">QuackGuru</b> ( talk ) 01:46, 7 March 2018 (UTC)

Support

 * Support as 2nd choice, as proposer. This proposal is more concise than the original. The following two sentences have been removed from this proposal: "Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances.[2] Consensus has not been established regarding the usual screening regimen.[1]" Everything else is the same as the original. <b style="color: #e34234;">QuackGuru</b> ( talk ) 01:47, 7 March 2018 (UTC)

Oppose

 * Oppose Has the same problems as above. Doc James  (talk · contribs · email) 13:15, 6 March 2018 (UTC)
 * Please be aware I reworded the proposal and it is much shorter than the previous one. What do you think about the new proposal? <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:25, 7 March 2018 (UTC)

3rd proposal to replace current wording in lead
[Please place your proposal here.]

Discussion on replacing or keeping current wording
The current wording suffers from citation bloat (also known as citation overkill). It also fails to provide highly useful information. For example, the lead provides absolutely no information regarding prostate cancer screening for those under age 50. Just saying it is controversial without any explanation does not provide any benefit for our readers. <b style="color: #e34234;">QuackGuru</b> ( talk ) 07:24, 6 March 2018 (UTC)


 * This is the same thing you wrote above. These tactics are not tolerable, Quackguru. Jytdog (talk) 15:59, 6 March 2018 (UTC)
 * I removed the quote and adjusted the proposals. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:26, 6 March 2018 (UTC)

There are issues with the current citations. For example, see the current wording "Prostate-specific antigen (PSA) testing increases cancer detection, but it is controversial regarding whether it improves outcomes.[10][11][12]" Does any source verify "...it is controversial regarding whether it improves outcomes."? Let's review. Source says "Randomized trials have yielded conflicting results.[16-18] Systematic literature reviews and meta-analyses have reported no clear evidence that screening for prostate cancer decreases the risk of death from prostate cancer, or that the benefits outweigh the harms of screening." Source says "Prostate cancer (PCa) screening is controversial." Source says "Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community." I would change it to "but it is unclear regarding whether it improves outcomes.[10]" I would also remove the other two citations ([11][12]). See WP:V policy. <b style="color: #e34234;">QuackGuru</b> ( talk ) 04:41, 7 March 2018 (UTC)

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

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

What do others think about this? Can anyone else verify the claim for the following sentence? "Testing, if carried out, is more reasonable in those with a longer life expectancy." If the content fails verification it should be removed or rewritten. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:42, 9 March 2018 (UTC)


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


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


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


 * Part of proposed wording for the lead: "The Canadian Urological Association in 2017 suggests screening be offered to those who are expected to live more than 10 years with the final decision based on shared decision making.[4] The starting age for most people is at age 50 and age 45 among those at high risk.[4]" This content has specific information for those over 50 and has specific information for those under 50. It also explains screening can be offered to those who are expected to live more than 10 years rather than the current vague wording stating ...those with a longer life expectancy. There is a clear difference between quality content and not very helpful content. See Talk:Prostate cancer for previous talk page discussion and see under Dangerous Wikipedia prostate suite of articles for continuing discussion on this topic. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:09, 7 March 2018 (UTC)


 * User: QuackGuru please pull these RfCs. Thanks. Jytdog (talk) 22:36, 9 March 2018 (UTC)
 * I assume you think it was premature? The issues can be addressed later for this page. There is no rush. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:18, 10 March 2018 (UTC)
 * Thank you for pulling them. Jytdog (talk) 17:28, 10 March 2018 (UTC)

2018 position
NCI says in Feb 2018

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

Have removed the 2013 Cochrane review as I agree it is old. And it is not needed. Doc James (talk · contribs · email) 14:20, 1 March 2018 (UTC)
 * It is irrelevant it is controversial. It does not tell the reader much. It may also be dangerous for our readers because readers may skip prostate screening or getting a second opinion after reading that. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)

POV
This is a POV edit, that cherry picks (mines) one source for one negative statement, and ignores the overall. It also removes reliably sourced information, with no discussion. I will tag the article as POV if these issues (and others outlined at WT:MED) go uncorrected for more than a few days. Doc James, you cannot just run through articles under discussion, doing with them as you wish. Please discuss. Sandy Georgia (Talk)  17:34, 1 March 2018 (UTC)
 * I have joined this discussion with the above. The discussion regarding this article should be occurring here.
 * Lets go through the sentences one by one if you wish. Doc James  (talk · contribs · email) 11:23, 2 March 2018 (UTC)
 * Lets stop waiting time by going through each sentence with the wrong version. SandyGeorgia and I have a clear problem with the old version. Is there any other editor supporting the old version? <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)
 * Sure so try a RfC and we can both present our sides and vote on it. If we contain content inline with the CDC, NCI/NIH, Cochrane, and USPSTF for a little longer it is not a big deal. Cancer always sucks but that does not mean we must now ignore a bunch of major sources. Doc James  (talk · contribs · email) 04:00, 3 March 2018 (UTC)
 * Both User:SandyGeorgia and I disagree. Does anyone else support the current wording? We should not ignore what other sources say that give more helpful content for a concise lead. <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:34, 3 March 2018 (UTC)

Sentence 1: Is PSA testing controversial?
Currently we say "Prostate cancer screening is controversial."

This is supported by a 2018 statement by the NCI the devision of the National Institutes of Health specifically for cancer. It is also supported by the World Cancer Report by the World Health Organization. Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)
 * Again, it is irrelevant it is supported by the citation. We should focus on content that benefits our readers. This content does not benefit our readers. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)
 * Telling readers that the medical community is divided on this issue is very useful. There is no "one truth" on this Doc James  (talk · contribs · email) 03:59, 3 March 2018 (UTC)
 * Telling readers prostate cancer screening is controversial is like telling them it is bad or even not that useful. That is not useful. There is better information on this. <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:34, 3 March 2018 (UTC)
 * I am OK with telling our readers that it is controversial, as long as we explain that the reason that it is controversial largely points back to the flaws in the USPSTF recommendations. That issue is very widely understood by urologists, and is explained quite well by Catalona.  We should be concerned, at Wikipedia, that we are supporting and furthering a recommendation that has been shown for several years now by reliable sources to be flawed ... to the extent that the USPSTF had to back down.  Catalona is not the only physician explaining that in MEDRS sources.  Just saying it is controversial does not add much.  The concerns are in multiple areas, and we do not distinguish.  1.  Men are running around getting biopsies when they don't need them (that is an education issue).  2.  Unscrupulous practitioners are offering, for example, radical prostatectomy for Gleason 6s.  That is an ethical issue.  3.  Because of 1 and 2, unnecessary treatment happened.  Then the USPSTF caused a decline in screening, which leads to a decrease in detection of treatable cancer, and an increase in non-organ-confined disease.  If you do not explain the specific controversy (which sources do well, try reading Catalona if you don't yet understand the problem), it sounds like the problem is with the PSA test per se, rather than how it is correctly or incorrectly applied.   Also, as long as this article does not do this correctly, it is too US centric, since the European study got it right.  Sandy Georgia  (Talk)  17:09, 3 March 2018 (UTC)
 * Please base discussion on what MEDRS sources say about medical decision making and what RS say about ethics; we of course need to apportion weight among reliable sources.  In my view we should give less WEIGHT to a ref calling for more testing by people with a financial stake in more testing.  The disclosure is on the paper to inform that kind of consideration. Jytdog (talk) 17:25, 6 March 2018 (UTC)
 * I have provided multiple sources that say the same as Catalona throughout talk page discussions on various articles in the prostate cancer suite. Catalona is not the only one explaining the problem:  he just happens to wrap it all up nicely in one article.  Sandy Georgia  (Talk)  16:56, 8 March 2018 (UTC)

Sentence 2: Does it change the risk of death from prostate cancer?
Currently we say "Prostate-specific antigen (PSA) testing increases cancer detection but it is controversial regarding whether it changes the risk of death from the disease."

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

Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)
 * The content is misleading because early detection saves lives. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)
 * No it is controversial. We have excellent refs which say it does not save lives. Doc James  (talk · contribs · email) 03:58, 3 March 2018 (UTC)
 * Early detection reduces mortality, especially for those who have a long life expectancy. <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:34, 3 March 2018 (UTC)
 * Doc James, we have sources that say both. We are stating as fact something that is not fact.  It is possible to say both.  You want to preference one source over others.  And if you talk to urologists who are engaged in the heart of this very research and controversy, you (and Wikipedia) are going to find yourselves on the wrong side of history in the not-too-distant future, because men are not going to keep silently suffering because of a misguided governmental action that resulted from Obamacare.  Sandy Georgia  (Talk)  17:12, 3 March 2018 (UTC)
 * Most of the recent sources say their is a small decrease risk of death from prostate cancer but due to overdiagnosis and over treatment it is unclear if it improves overall risk. Have adjusted to match that. Doc James  (talk · contribs · email) 12:14, 5 March 2018 (UTC)

Sentence 3: Informed decision making
This is what we currently say "Informed decision making is recommended when it comes to screening among those 55 to 69 years old." This is somewhat US centric but IMO is not unreasonable.

Doc James (talk · contribs · email) 11:23, 2 March 2018 (UTC)
 * We should try to find another source for screening under 50 years of age to replace the current wording. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)
 * Why? Doc James  (talk · contribs · email) 03:58, 3 March 2018 (UTC)
 * This is the same organization that was previously against screening. They recommend informed decision making rather than encourage screening. Early detection reduces mortality, especially for those who have a long life expectancy. Cancer can be diagnosed earlier before it spreads. <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:34, 3 March 2018 (UTC)
 * Why? Catalona explains it.  There are plenty of reliable sources, and in practice, many urologists call for baseline screening when a man is in his 50s.  Anecdotally (personally), I will explain why.  My husband's 2.97 was cancer.  Another man's 2.97 may not be cancer.  If you don't establish a baseline, it can be harder down the road to know when a biopsy or more careful scrutiny is needed.  Catalona explains that.  Other sources explain that.  Urologists know it.  And, we need to take greater care to address the higher-risk populations in the lead, because they are the people most likely to be consulting this article (PCa in family history, or African-American).   It is not to difficult to add a few qualifying words to that sentence to make it clear it applies only to some populations.  Sandy Georgia  (Talk)  17:17, 3 March 2018 (UTC)

Additional details
Wondering peoples thoughts on this?

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

"

Doc James (talk · contribs · email) 11:43, 2 March 2018 (UTC)
 * I think it might be a problem if the article is excessively reliant on US material. Different countries may weigh risk/benefit analyses differently, for one thing. Jo-Jo Eumerus (talk, contributions) 11:44, 2 March 2018 (UTC)
 * User:Jo-Jo Eumerus this is an Australian source. It also comments on conclusions in other countries with
 * "The consensus from recommendations from other parts of the world is geared against a routine test for PCa using a PSA test. In general, the view that routine PCa testing is not recommended is held by the American Academy of Family Physicians and The US Preventive Services Task Force. More specifically, The American Urological Association (AUA) recommends against PCa screening in men aged < 40 years and in men aged ≥ 70 years with a life expectancy of < 10 years. Furthermore, the AUA stance on asymptomatic men is that the greatest benefit of routine screening can be found in men aged 55–69 years."
 * Doc James (talk · contribs · email) 11:46, 2 March 2018 (UTC)
 * The greatest benefit is different for each individual. Bundling every person into an age group is very dangerous. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:36, 2 March 2018 (UTC)
 * If you talking about "the greatest benefit of routine screening" you are obviously talking on a population basis. Disentangling the population view (screening) from the individual view (testing) is one of the big problems with these articles, as I have suggested on the project talk. Johnbod (talk) 16:41, 2 March 2018 (UTC)
 * General recommendations can be dangerous for an individual. We should not repeat unhelpful content in the lead when we know different people have different circumstances. I will focus on helpful content rather that irrelevant content such as stating it is controversial. <b style="color: #e34234;">QuackGuru</b> ( talk ) 16:53, 2 March 2018 (UTC)
 * It is not our job to decide what is "helpful", rejecting everything else as "irrelevant". But as I say, we need a clearer view of the position for individuals, as opposed to the population issues involved in "screening". Overtreatment is also dangerous for the individual (though obviously it may not be as much so as lack of a diagnosis), and is one of the main objections to routine screening. Johnbod (talk) 17:04, 2 March 2018 (UTC)
 * A 2018 review states, "In the aftermath of the USPSTF recommendations, the widespread rejection of screening by many primary care physicians has had far-reaching consequences, notably, a reversion to more PCa cases being high-grade and advanced at diagnosis."


 * This and other pages repeated the previous USPSTF recommendations. We should not continue to repeat past mistakes. The previous USPSTF recommendations directly lead to high-grade cancer and premature death. Focusing on helpful content is a much better idea that continuing to state it is controversial. Stating it is controversial may promote the rejection of screening among our readers. <b style="color: #e34234;">QuackGuru</b> ( talk ) 17:15, 2 March 2018 (UTC)
 * Were does the ref say "The previous USPSTF recommendations directly lead to high-grade cancer and premature death"? I am not seeing it?
 * The quote you give does not support that. Yes if fewer prostate cancer cases are diagnosed overall a greater proportion of those that are diagnosed are high grade. The question is about changes in absolute numbers.
 * The 2018 USPSTF says "The Task Force continues to find that the potential benefits and harms of screening are closely balanced." Doc James  (talk · contribs · email) 03:57, 3 March 2018 (UTC)
 * A "reversion to more PCa cases being high-grade and advanced at diagnosis" directly or indirectly lead to high-grade cancer and thus premature death because "in the aftermath of the USPSTF recommendations, the widespread rejection of screening by many primary care physicians has had far-reaching consequences". What where the consequences? Notably, "a reversion to more PCa cases being high-grade and advanced at diagnosis." <b style="color: #e34234;">QuackGuru</b> ( talk ) 15:24, 3 March 2018 (UTC)


 * In general terms, Doc James, because prostate cancer is typically slow growing, treatment is all about life expectancy. But, as Catalona points out, the average life of a 70-year-old man in the US will extend another 15 years, which makes detection of prostate cancer a concern even at 70.  There are reputable surgeons looking at very healthy physically fit and active 70-year olds who are doing radical prostatectomy because those men have still good life expectancy, and for example, Memorial Sloan Kettering employs life expectancy tables in decision making.  Certainly the NCCN hospital we are at does so as well-- they won't even talk treatment without involving life expectancy.  And they, like you, would like to see the unscrupulous surgeons and operators shut down, but not by letting more men with legitimate cancer and good life expectancy die.  Informed decision making over black-and-white thinking.  Our article is black-and-white, and that is not how prostate cancer detection and treatment is addressed by experts (that is, once you get out of the hands of the dumb USPSTF-influenced GP, who would put you out to pasture to die.)  This article will not be fixed by cursory editing-- in-depth knowledge and review of sources is needed-- of the sort Johnbod is capable.  One in six-- I hope any man resisting corrections here is spared.  It is possible to responsibly address the controversial aspects. Sandy Georgia  (Talk)  17:26, 3 March 2018 (UTC)
 * We have a lot of sources that have come to the same position as the USPSTF including the World Health Organization, Cochrane, and the NHS.
 * We reflect their positions, the new draft statement form the USPSTF, as well as that of Catalona.
 * Even though prostate cancer is supper common most people who get it do not die from it. Doc James  (talk · contribs · email) 12:25, 5 March 2018 (UTC)
 * Yes, the articles are better now because more positions are reflected than the deadly and outdated 2012 USPSTF source. Correct, most do not die from prostate cancer (but more do now as a result of USPSTF).  And with reversion to more prostate cancer being detected when it is beyond the stage of cure (because of the decline in screening caused by the USPSTF), the issue is about quality of life lived rather than time lived. Focusing ONLY on life expectancy is not what treating urologists and oncologists do, and is a mistake in this article. More men diagnosed at later stage means more of them will live with urinary incontinence, fecal incontinence, erectile dysfunction, and-- in the case of hormonal therapy-- mood swings, depression and the like.  The article must deal with the whole story-- quality of life and life expectancy-- just as practicing urologists and oncologists do.  Reliable sources do this, also.  Please include in your reading base literature written by physicians as well as governmental sources.  Many sources cover the full picture and explain what Catalona explains.  The problem with the proposed statement (above) is that it just doesn't say anything or add anything. Sandy Georgia  (Talk)  16:53, 8 March 2018 (UTC)
 * What reference are you using to support this "More men diagnosed at later stage means more of them will live with urinary incontinence, fecal incontinence, erectile dysfunction, and-- in the case of hormonal therapy-- mood swings, depression and the like."? Many say the exact opposite. The % of males with "prostate cancer" has dropped in half in the United States over the last 30 years as screening has decreased. Doc James  (talk · contribs · email) 17:37, 10 March 2018 (UTC)
 * diagnosed with - that is all we can say. Johnbod (talk) 17:44, 10 March 2018 (UTC)
 * Regarding "Correct, most do not die from prostate cancer (but more do now as a result of USPSTF)." — you can't say that. More die as a % of those diagnosed, but in absolute terms no more are dying — or at the very least no such correlation has been made based on evidence.
 * Such statements are fraught with confounding factors, and even if more men die from prostate cancer today than 10 years ago, that could be because life expectancy is higher, and mortality from cardiovascular disease is down.
 * We need to stick with the highest possible standards of evidence, and unfortunately much of the current discussion is driven by emotion. Carl Fredrik  talk 18:32, 10 March 2018 (UTC)

Claim that USPSTF statement in 1996 has been harmful


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


 * Doc, could you try not to put links in subject headings? This is very old interpretation of data, and original research on that data (which amounts to, a little bit of information is a dangerous thing).  Catalona explains it. PMID 29406053  So does the other source I gave that explains same as Catalona. PMID 27995937 You also fail to notice that quality of life and life expectancy are not the same thing.  That is, would you like to live for ten years with fecal incontinence?  The entire story of prostate cancer is not told with life expectancy.  That is why the sources discuss that USPSTF caused a reversion to more advanced cases being detected.  Rather than trying to argue a POV, why not just make sure the article includes all sides of the controversy?  It's not hard.  Sandy Georgia  (Talk)  00:44, 6 March 2018 (UTC)
 * Agree the whole story of prostate cancer screening is not told by life expectancy alone. Between 20 and 50% of cancers diagnosed are over-diagnosed. Many of these overdiagnosis result in a radical prostatectomy. "A meta-analysis of the harms of radical prostatectomy concluded that 1 man will experience substantial urinary incontinence for every 6 men who have a radical prostatectomy rather than conservative management (95% CI, 3.4 to 11.7) and 1 man will experience long-term erectile dysfunction for every 2.7 men who have a radical prostatectomy rather than conservative management (95% CI, 2.2 to 3.6)." Doc James  (talk · contribs · email) 13:15, 6 March 2018 (UTC)
 * Doc, perhaps you can agree that there is a basic logical error in "overdiagnosis results(s) in a radical prostatectomy". It is not the diagnosis that results in over treatment.  Yes, there are Gleason 6s running around hysterically demanding treatment,  and there are unscrupulous practitioners preying on that irrational fear to make money.  One in six men will be diagnosed with prostate cancer, and it is a cash cow.  That there are fearful patients being operated on by unscrupulous physicians does not mean there is a problem with the diagnosis per se.  Individual differences aside (e.g., if I had a prostate and a family history of aggressive prostate cancer and the BRCA gene, I would ask to have surgery even with a Gleason 6), no scrupulous surgeon will take out a prostate with a Gleason 6 ... and yet, it is happening.  This is a different problem than the concern that PSA screening leads to biopsy leads to surgery.  We need to incorporate the sources that deal with the whole issue.  You, Doc, in particular are over focused on prioritizing the ignorant patient and the unscrupulous surgeon over the gazillions of men whose lives are saved by PSA screening. I do not believe you would operate that way in the real world, and I do not think that is how you would treat your own prostate.   Sandy Georgia  (Talk)  16:47, 6 March 2018 (UTC)
 * There are adverse outcomes beyond radical prostatectomy, including: unnecessary fear and anxiety, biopsy, and adverse outcomes of biopsy such as infection, bleeding, and in some cases death. Carl Fredrik  talk 18:36, 10 March 2018 (UTC)
 * Agree with CFCF the concerns with screening do not pertain to death from prostate cancer (may be slightly decreased) but increased harm due to unneeded testing and treatment. Doc James  (talk · contribs · email) 21:20, 12 March 2018 (UTC)
 * Catalona says the 2008 and 2012 USPSTF recommendations led to a decrease in PSA testing in the US. Who claims that USPSTF statement in 1996 has been harmful? <b style="color: #e34234;">QuackGuru</b> ( talk ) 06:22, 6 March 2018 (UTC)

Can we use a new (but old enough to be WP:MEDRS) screening review please?
I'd prefer that all references to old, bad guidelines, whether they were, are, or might still in the future be controversial, and pretty much all the previous article issues discussed on this page be replaced with a summarization of e.g. instead. Here's its abstract:
 * In this chapter the use of prostate specific antigen (PSA) as a tumor marker for prostate cancer is discussed. The chapter provides an overview of biological and clinical aspects of PSA. The main drawback of total PSA (tPSA) is its lack of specificity for prostate cancer which leads to unnecessary biopsies. Moreover, PSA-testing poses a risk of overdiagnosis and subsequent overtreatment. Many PSA-based markers have been developed to improve the performance characteristics of tPSA. As well as different molecular subforms of tPSA, such as proPSA (pPSA) and free PSA (fPSA), and PSA derived kinetics as PSA-velocity (PSAV) and PSA-doubling time (PSADT). The prostate health index (phi), PSA-density (PSAD) and the contribution of non PSA-based markers such as the urinary transcripts of PCA3 and TMPRSS-ERG fusion are also discussed. To enable further risk stratification tumor markers are often combined with clinical data (e.g. outcome of DRE) in so-called nomograms. Currently the role of magnetic resonance imaging (MRI) in the detection and staging of prostate cancer is being explored.

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

Is there a suitable open access substitute? Bexoen (talk) 20:14, 10 March 2018 (UTC)
 * That ref is PMID 26530362 and is indeed fine. However the section on screening here should just be the WP:LEAD of Prostate cancer screening with refs added, per WP:SUMMARY and WP:SYNC. In that article, the section on PSA should in turn be the lead of the Prostate-specific antigen with refs added, again per WP:SUMMARY and WP:SYNC.  Doing this right, we update PSA, then the screening article, then this last. Jytdog (talk) 20:29, 10 March 2018 (UTC)


 * That is a MEDRS source and can be used, but not to the exclusion of other, or more recent, sources (that is how bias is created). Note that a book published in 2015 will contain research considerably older than 2015, and we have 2016 and 2017 reviews. Jytdog is right that the sub-articles should all be addressed first so they can be used as building blocks for this article, which should use Summary Style, but there are many more articles than just PSA and screening-- for example, there is a biopsy article, prostatectomy, and staging which are all also dismal.  Optimally, they would all be updated before this article is addressed, and at the end of that process, we end up with the lead to this article.  With respect to SYNC, it offers a suggestion that rarely works in practice in higher level, well-written articles.  Note that the wording of the guideline (my emphasis) is "it can be convenient to use the sub article's lead"-- that is not even a recommendation.  It is a helpful suggestion for beginning editors or for new suites articles, but rarely works in practice for more advanced content.  How useful that suggestion is depends on how the top summary article is organized.  Sandy Georgia  (Talk)  13:43, 16 March 2018 (UTC)
 * Outdatedness is not bias. It is just outdatedness. But yes we should use the most recent, highest quality refs, always.  Especially on this topic where we have a lot of unusual intensity.
 * And yes, all the sub-articles need to be updated so we can feed them into the main article.
 * I have found that bringing the lead over is the most simple/rational way to handle the SYNC/SUMMARY thing, as a rough starting point; yes any given actual lead often needs to be tweaked once it is brought over, in order to make it fit well into its actual new context. Those tweaks also need to stay in tune with the subarticle. Jytdog (talk) 14:05, 16 March 2018 (UTC)

OPPOSE the whole lot of RFCs
I am not participating in the massive filling up of this page with RFCs. I consider all efforts to work on only the lead a mistake in editing that should be reserved for novice editors. I also consider that the various "sides" in this debate are simply refusing to hear the others. Leads are summaries, and the body of the article is a mess. Cleaning up the body will fix the lead. You agree on content in the body-- later you summarize that to the lead. Experienced editors should stop this thinking that they can only clean up leads, and ignore bodies of articles. Further, there is original research throughout these talk page discussions -- doctors and lay persons arguing their case without consulting sources. You don't get to just leave out a whole ton of reliable sources because you don't personally agree with them. Treating prostate cancer is particularly difficult, because no two cases are alike, and yet we have people here arguing from the naive (a position of not having or treating cancer, and yet ignoring reliable sources from those who do). Furthermore, jumping to RFCs when valid discussion is happening is not helpful. And RFCs are likely to just bring in people who have no knowledge of medical issues or medical editing. The problem in this entire suite of articles can be summarized as one POV that has been given preference over multiple other reliable sources. That is slowly changing. Start listening to each other and using all sources-- not just government sources with one POV. Clean up the POV in the article, the lead will fix itself. Canada, by the way, is by no means the only area left out of this article. Sandy Georgia (Talk)  17:00, 6 March 2018 (UTC)
 * PS, I am off now to the hospital for an overnighter. That means, if I am able to edit, it will be from an iPad, with resulting typos, edit summaries, etc.  Sorry in advance.  I catch up as I am able from a real computer.   Sandy Georgia  (Talk)  17:23, 6 March 2018 (UTC)
 * Agree these are premature. It is unfortunate the discussion of these articles has become so combative. As we have seen elsewhere, this will slow improvement, by keeping others from contributing. Johnbod (talk) 18:18, 8 March 2018 (UTC)
 * (summoned here by the RFC bot) I support the idea that the work on the lead must be mostly about the improvements it adequately covers the article. That the lead requires a lot of footnotes is a big bright red flag the article body is inadequate. Staszek Lem (talk) 18:47, 8 March 2018 (UTC)

Citations in the lead

 * We typically add references to the lead for medical articles. This lead is similarly referenced to 100s of other medical articles. Doc James  (talk · contribs · email) 17:36, 10 March 2018 (UTC)
 * Well, then IMO something is wrong with writers of medical articles so that they do not follow WP:LEAD. Alternatively, something is wrong with WP:LEAD: if there are too many exceptions from a rule, time to rewrite the rule based on community experience. Staszek Lem (talk) 16:27, 12 March 2018 (UTC)
 * For context, User:Staszek Lem, it's my understanding that to hasten broad coverage of our medical content in other languages, the translation project has often been translating only the lead of many articles. To facilitate that in turn, several of us have been insuring that everything in the lead of medical articles is sourced. It is true that WP:LEAD says they are not necessary and that remains true.  But for this purpose they are very useful.  And I agree that in other contexts, lots of refs in the lead is a sign of trouble.  It isn't, in medical articles. We should add a note about this to MEDMOS. Jytdog (talk) 16:34, 12 March 2018 (UTC)
 * Not only MEDMOS, but WP:LEAD as well. Just you wait until some zealous wikignome decides to "clean up" these overfootnoted leads brandishing the guideline into your face. Happened with me quite a few times. Staszek Lem (talk) 16:42, 12 March 2018 (UTC)
 * WP:LEAD says "The verifiability policy advises that material that is challenged or likely to be challenged, and direct quotations, should be supported by an inline citation. Any statements about living persons that are challenged or likely to be challenged must have an inline citation every time they are mentioned, including within the lead.... The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus."
 * There is no "prohibition" of references in the lead. Local consensus is at WP:MEDMOS were use is supported. Doc James  (talk · contribs · email) 21:18, 12 March 2018 (UTC)
 * No, we need not include citations in lead, and forcing them (and 12-yo language) into leads for a different project (translation) not only results in less than optimal leads-- it also has resulted (as in this suite of articles) in important parts of the bodies of articles being neglected.  The lead is a summary of the whole article-- not a select set of facts that are for translating on a 12-yo level.  And, the problem in THESE articles is just that ... the leads do not summarize the articles, do not summarize the conditions, and reflect select cherry-picked facts for translation.  Further, with respect to MEDMOS and MEDRS, we had to jump through quite a few hoops back in the day to get those pages accepted as guidelines, and part of getting them accepted was making sure that they did not contradict project-wide guidelines, like LEAD and MOS.  MEDMOS needs to stay in sync with the rest of the project, or we risk their acceptance as guidelines.  This "local consensus at MEDMOS" is overridden by project-wide guideline.  This line of thinking drives down the overall quality of medical articles, with attention focused on making them readable at a 12-yo level so they can be translated, and is perhaps is why the growth here has stalled.  Sandy Georgia  (Talk)  13:26, 16 March 2018 (UTC)
 * Or maybe FA has stalled because many people (like me) do not care about these badges. There is so much work to do always, with just basic maintenance like keeping things updated.  Jytdog (talk) 14:45, 16 March 2018 (UTC)
 * I have also received similar pushback about references in the lead of medical articles citing this style guide. I agree that it should be addended to avoid further confusion since many editors who primarily work outside of the medical project are unaware of the above caveats. TylerDurden8823 (talk) 16:01, 16 March 2018 (UTC)
 * I agree with Jytdog here, the decrease in medical FAs has nothing to do with not reaching FA requirements. Rather it is that our own requirements are nearly always far beyond what FA requires, and getting referenced ledes through FAR has not been a problem. The reason no one is working on FAs for medical articles is that the effort to reward ratio is awful. So what if it's featured on the main page when the article gets 30.000 views a day as it is? WPMED quality control is frankly better than FA, and GA is horrible. I've seen articles that are extremely factually inaccurate reach GA. Carl Fredrik  talk 15:58, 19 March 2018 (UTC)
 * I tend to agree - Sandy, as you keep saying there are so many terrible medical articles, even dangerously so, and at the point where a big medical article has been got to be accurate and up to date in essentials, editors are presented with the choice of going on and doing that to probably at least 2 more articles, or spending the same amount of effort taking the first one through FA. Given the wholly different importance of the articles to many readers (another point you rightly keep making), it's understandable if people choose the first path. I have to say I've pretty much given up writing my own FAs, though I still review some, as I think this argument applies even to art history - it's just more useful to get a series of bad articles up to a decent standard, and leave them there. I personally support the emphasis on leads, not just for translation purposes, but for a high proportion of our English-speaking readers, who seem to include great numbers of second-language English speakers, who prefer (trust) English WP over say the Polish or Spanish one, though they may look at that as well. Many only read the lead, plus maybe one or two sections that especially interest them, before moving on to other internet sources, as my research at CRUK showed. Johnbod (talk) 16:23, 19 March 2018 (UTC)

STAMPEDE
STAMPEDE started in 2005 and results for phase 1 and 2 have been reported. These results are affecting treatment decisions and are used as justification for those decisions. This can hardly be called "WP:RECENTISM, unencyclopedic", perhaps a perusal of the reports in The Lancet might clarify things for you? Of course if you believe there is a better place in the article to link to research than this section, feel free to move the link there. Martin of Sheffield (talk) 21:57, 12 October 2019 (UTC)
 * STAMPEDE (clinical trial) could be in 'see also'. I think information from a result of the trial would be needed for a mention in the body of this article, or at least some information. Johnuniq (talk) 22:11, 12 October 2019 (UTC)
 * There are reported results given at STAMPEDE_(clinical_trial). Do you want the whole section copied over? Martin of Sheffield (talk) 22:13, 12 October 2019 (UTC)
 * There appear to be no reviews on its use for diagnosis, or even if the therapy regimens under study are effective in a sufficient population to warrant clinical or regulatory approval. There is a 70% failure rate for Phase II and 50% failure of Phase III trials. IMO, it is unencyclopedic to include research-in-progress; WP:MEDREV. --Zefr (talk) 22:19, 12 October 2019 (UTC)
 * I'm suprised at that comment. I followed the link you provided and the first entry was  in which the abstract contains: "CONCLUSIONS: Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available.  PATIENT SUMMARY: Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body."  Now I'm not a doctor.  I came to this trying to understand the letter from my oncologist to my GP which referred to STAMPEDE results as the basis for the proposed course of treatment.  This is Wikipedia, a public encyclopaedia, to which anyone should be able to turn to find out information and where to go for details.  I do note that the abstract quoted above reports the STAMPEDE in an official US government publication, so the work has been noted outside of the UK.  As I said originally, feel free to insert the summary or link where you,  and other medics consider most appropriate.  Regards, Martin of Sheffield (talk) 10:09, 13 October 2019 (UTC)
 * your reasoning is understandable and I regret to see your diagnosis and treatment; best of luck as you proceed. The article quotes you provided are not definitive for an encyclopedia; STAMPEDE is still a work-in-progress. Wikipedia does not provide clinical guidance or advice, WP:NOTADVICE, but rather has the goal of stating the best-established facts, as discussed in WP:MEDASSESS, where the "level of evidence" concerning the STAMPEDE program is not yet universally accepted or critically reviewed where it has broad consensus in the clinical community, WP:MEDSCI. Other editors may disagree, so let's allow the discussion to unfold. --Zefr (talk) 16:45, 13 October 2019 (UTC)
 * I agree; the whole "research" section could do with an update. Best of luck with the treatment. Johnbod (talk) 03:25, 14 October 2019 (UTC)

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

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

Added from three Cochrane reviews: - A section on hypofractionation as a type of radiation treatment - A comparison of diagnostic techniques for prostate cancer - A paragraph on using taxane-based chemotherapy in addition to hormone therapy These edits improve the quality of information about potential treatments to medical issues relating to prostate cancer. --Gsom12812 (talk) 16:36, 24 February 2021 (UTC)
 * I have reverted your additions for multiple reasons, the most serious being cut-and-paste WP:COPYVIO from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483565/, which by the way, is the most recent version of the dated Cochrane study you were citing. Please provide PMIDs in your citations; I could have saved a lot of time if I could have gone straight to the correct review; the most recent is 31022301, while I could not locate the older one you were citing in PUBMED. Also, please review and respect WP:CITEVAR; this article uses the Diberri-Boghog template, https://citation-template-filling.toolforge.org/cgi-bin/index.cgi which generates a citation template by plugging in the PMID:
 * Also, please see MOS:BOLD and MOS:BADITALICS. And before I had to revert the whole thing as cut-and-paste plagiarism, please review the changes I had made to reduce excess detail.   Further, considering that management of prostate cancer exists, this is mostly excess detail in this article. Sandy Georgia  (Talk)  18:58, 24 February 2021 (UTC)
 * Also, please see MOS:BOLD and MOS:BADITALICS. And before I had to revert the whole thing as cut-and-paste plagiarism, please review the changes I had made to reduce excess detail.   Further, considering that management of prostate cancer exists, this is mostly excess detail in this article. Sandy Georgia  (Talk)  18:58, 24 February 2021 (UTC)


 * Thank you for giving me this feedback. I am working as a part of the Cochrane-Wikipedia project to bring the results from a number of Cochrane review papers on prostate cancer to the relevant Wikipedia pages. As I continue to work with them, I will likely have to add in the information from the edits you reverted again and so I wondered if you would be able to give me an idea of how to do this more effectively so as to not have these edits reverted in the future. Is there a way to make it clearer that I am using this information with Cochrane's permission and am thus paraphrasing essentially all of the information from the plain language summaries provided in the Cochrane articles? As for the citation, I apologize for the time it took you to find the review. I am using the DOIs provided me by Cochrane to create the citation with Wikipedia's tool. I will try to find if there are updated versions of the articles I am provided in the future. --Gsom12812 (talk) 15:16, 25 February 2021 (UTC)
 * please see discussion at Talk:Management of prostate cancer, here.. Sandy Georgia (Talk)  22:32, 25 February 2021 (UTC)

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

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

Study sponsored by Dairy Organization in Spain

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

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

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


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

PSA screening

 * Sandy Georgia (Talk)  02:54, 18 March 2021 (UTC)

Sexual activity
Two reputable medicine schools, namely, the Mayo Clinic and Johns Hopkins University, diverge on the question of whether frequent ejaculation prevents prostate cancer: 1) https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prevention 2) https://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer/faq-20057800 Who's right? I,SphericalEarther (talk) 07:11, 24 October 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 25 November 2019 and 21 December 2019. Further details are available on the course page. Student editor(s): Marmasphan.

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Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 September 2020 and 11 December 2020. Further details are available on the course page. Student editor(s): Mgmswim. Peer reviewers: Cjn2075.

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Wiki Education Foundation-supported course assignment
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Wiki Education assignment: Technical and Scientific Communication
— Assignment last updated by Nneiman1 (talk) 16:04, 21 September 2022 (UTC)

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

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

1. The long-standing version is a silly tautology. No matter how long that version was in place, it should not be tolerated:
 * Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men.

2. Reywas92 pointed out that stupid situation and fixed it here:
 * Cancer of the prostate is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men.

3. While there is no rule that requires the first words must exactly repeat the title of the article, when it's possible to do so in a natural manner, it is usually best to do so. That would produce this version:
 * Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men.

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


 * 3. This version flows nicely and works. Wikilinking of the right words is easily achieved later. -- Valjean (talk) (PING me) 15:50, 17 March 2023 (UTC)
 * Interesting thoughts. How about lung cancer, liver cancer and so on. Would you want to change all of those for consistency, because I think consistency has tended to be the trend in my short time here. CV9933 (talk) 16:03, 17 March 2023 (UTC)
 * Consistency isn't a requirement, but when it works nicely it's a good thing, and both of those articles follow the pattern used in Number 3. -- Valjean (talk) (PING me) 16:09, 17 March 2023 (UTC)
 * 3 is fine. This at least goes directly into other facts; the liver cancer and lung cancer articles are also poor tautologies that should be changed. Reywas92Talk 16:16, 17 March 2023 (UTC)
 * Good point. Somehow, with my limited mouse-hovering-view, I missed that. They should be improved as well. -- Valjean (talk) (PING me) 16:38, 17 March 2023 (UTC)

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


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

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


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

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


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

2017 systematic review
Hi, I'm sorry to revert your recent addition to Prostate_cancer. 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)