- The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.
The article was promoted by Gog the Mild via FACBot ( talk) 22 April 2024 [1].
Prostate cancer
In 1 in 8 men, some cells in a small gland beneath the bladder go haywire. They grow and grow, eschewing the checks meant to bind them in place, and evading the ever-watchful immune system. Some split off the growing tumor, settling most often in nearby bones. In their race to grow, they digest the bone beneath them, causing excruciating pain and bone fractures. 350,000 men succumb to the disease each year, making prostate cancer the second deadliest cancer in men (after lung cancer, the subject of a 2023 FAR). Many thanks to SandyGeorgia, Colin, and Femke for shaping the article with their suggestions and feedback. My intention is that the article be clear to the medicine-literate and medicine-uninitiated alike, so please have a look and let me know what you think. Ajpolino ( talk) 20:00, 21 March 2024 (UTC)
- Former featured article: Reminder to update the page and numbers at
WP:FFA upon promotion.
SandyGeorgia (
Talk) 14:48, 17 April 2024 (UTC)
- Done, thanks Gog and DrKay! SandyGeorgia ( Talk) 20:32, 22 April 2024 (UTC)
Graham Beards
Support My (few) comments were addressed on the article's Talk Page along with more extensive ones from other reviewers. In my view, this is a well written and well referenced medical article. I made a few very minor edits today for the nominator's consideration. Graham Beards ( talk) 12:55, 22 March 2024 (UTC)
- Comment: how well-covered in medical literature is the topic of prostate cancer in
trans women? I see a couple sources from a quick Google search
[2]
[3]
[4].
Elias 🪐 (dreaming of Saturn;
talk here) 08:56, 22 March 2024 (UTC)
- Good point. It's well enough covered that we should have something in the article. I'll add a bit.
Ajpolino (
talk) 11:50, 22 March 2024 (UTC)
- I've added a short paragraph. Pardon the clunky euphemism "Special populations", it's a
MEDMOS suggestion. If folks prefer, we could swap it for a more direct heading like "Transgender women" or "Transgender populations". Or the info could be split up into the article sections each fact corresponds to.
Ajpolino (
talk) 20:04, 22 March 2024 (UTC)
- Thank you; I believe the current amount of information you've added is sufficient given the research around transgender people in medical contexts is still pretty recent. I think I prefer the last approach @ Ajpolino, as having a dedicated section singles them out and would probably be frowned upon by our trans laypeople readers. Of course, I would like the opinions of other, more experienced medical editors in this regard if ever anyone disagrees with me. Elias 🪐 (dreaming of Saturn; talk here) 02:42, 26 March 2024 (UTC)
- I've added a short paragraph. Pardon the clunky euphemism "Special populations", it's a
MEDMOS suggestion. If folks prefer, we could swap it for a more direct heading like "Transgender women" or "Transgender populations". Or the info could be split up into the article sections each fact corresponds to.
Ajpolino (
talk) 20:04, 22 March 2024 (UTC)
- Good point. It's well enough covered that we should have something in the article. I'll add a bit.
Ajpolino (
talk) 11:50, 22 March 2024 (UTC)
HF
I'm not familiar at all with medical stuff, but will try to review this over the weekend. Hog Farm Talk 13:11, 22 March 2024 (UTC)
- "The sum of the most common two assigned numbers is the "Gleason score".[27] Gleason scores of 2 through 5 are no longer commonly used in practice, making the lowest Gleason score 6, and the highest 10. " - this doesn't entirely make sense to me. Is this saying that, for instance, a score of 2 and 3 is unlikely to come up?
- I've rephrased this paragraph since Femke and Draken Bowser both found it unclear as well. Take a look and see what you think. I've added a footnote to answer your exact question. In short, it's a historical quirk. The "Gleason grade group" system (with grade groups 1-5) is meant to eventually replace the Gleason score. The old Gleason score system had scores 2–10; the current one has scores 6–10, and is living alongside its successor that runs 1–5. Despite both being five-point scales, the current 6–10 score doesn't map perfectly onto the successor 1–5 scale. I'm having trouble clearly communicating that part, so if you have any suggestions I'm all ears. Ajpolino ( talk) 19:46, 27 March 2024 (UTC)
- " called castration-resistant prostate cancer (CRPC)" - does this imply that castration is a potential treatment for this cancer? This appears to be discussed a bit in the history section, but the discussions on treatment leave this question unanswered
- In medical jargon land, we call
removing your testicles "surgical castration" and eliminating your body's testosterone
with drugs "chemical castration". I've added
(also called "chemical castration")
to the first mention of the treatment. Do you think that would suffice to reduce a reader's surprise when they make it to "castration-resistant"? To your direct question, surgical castration is still occasionally used for prostate cancer, but its use is declining (3.5% and falling as of 2016). Most recent sources only mention it in passing if at all, noting only that patients tend not to choose it. As such, I haven't covered it in the article, but certainly could add a couple sentences if you think it would be helpful context.
- In medical jargon land, we call
removing your testicles "surgical castration" and eliminating your body's testosterone
with drugs "chemical castration". I've added
- "Depends on stage, five-year survival rate 97%" - if this is important enough for the infobox, should it be in the body of the article as well?
Excellent work; I expect to support. It perhaps says something that I have no issues writing content about horrible Civil War combat, but I spend most of the read-through of this article shuddering in horror. Hog Farm Talk 00:33, 27 March 2024 (UTC)
- Thanks much for your time and feedback. I'm gratified that the article elicited any response besides boredom. FWIW, a glance at American Civil War's infobox suggests your chance of surviving a bout with prostate cancer (as one or both of us might) are better than a man's chance of making it through the war alive. Not sure if that reflects more positively on the prostate cancer experience, or negatively on the Civil War experience. Probably the latter. Ajpolino ( talk) 21:31, 27 March 2024 (UTC)
Support from Femke
As I said at the end of my GA review, I believe the article now meets the FA criteria. —Femke 🐦 ( talk) 16:45, 22 March 2024 (UTC)
Support from Draken Bowser
Just like the new and improved lung cancer i find that the article is readable and offers a nice balance between completeness and conciseness. I have but a few suggestions:
- "Men with high PSA levels are often recommended to repeat the blood test four to six weeks later, as PSA levels can fluctuate unrelated to prostate cancer." I think it's perhaps of more interest to mention how PSA-levels spike in response to
UTI:s and
urinary retention, or do both sentences.
- Recent reviews seem not to mention UTIs and urinary retention as PSA raisers, any idea why? I'm not familiar enough with the field to know. Carlsson 2021 mentions only BPH; the Harrison's chapter I use heavily mentions only prostatitis and BPH (Scher 2022); Rebello 2021 mentions only prostatitis and BPH; public-facing CDC site gives "certain" procedures/medications, BPH, and infection; similar ACS site gives a longer list but no UTI. To your more general point I've added two short sentences on what can raise and lower PSA levels. Hope you feel that improves things. Ajpolino ( talk) 18:28, 27 March 2024 (UTC)
- No idea why, in clinical practice I've regularly seen spikes above 20 in patients with a recent UTI, which then recedes to a baseline of ~1,5 within 2–3 months (just to be clear, I'm not the bozo ordering these PSA-tests :P). Maybe it's the good old case of experts refusing to repeat the obvious. Looks good now. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- "...and lead to unneeded biopsies and treatments." I think this sentence should also follow up with the word "complications", to stress clearly that it is not only an issue of resource allocation and mental health, but something that carries a risk of physical health issues. This is of course already explained elsewhere, but I'd still make the addition here.
- My brain shuts down trying to read the section on Gleason scores. While I'm not a native speaker I'm also concerned there is an accessibility issue.
- Femke had a similar concern at GAN, and I see it was unclear to Hog Farm above as well. I've tried some editing to hopefully clarify. Is it any better? I'm not sure how to clearly phrase the part about Gleason scores of 7 being converted into Gleason grade group 2 or 3. The fact that there's so many numbers named Gleason makes it challenging to communicate clearly.
- Yeah, it's better and the efn is a nice touch. If I get any ideas on further improvements I'll get back to you. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- I think the article should briefly discuss pre-biopsy MRI.
That's all and once again, excellent work. Draken Bowser ( talk) 17:16, 26 March 2024 (UTC)
- Oh and one more thing. The section on radiotherapy mentions the diagnosis bladder cancer as a complication, but lists only symptoms related to radiation proctitis, without mentioning the diagnosis by name. I'm not sure if adding it is an improvement, but I thought it was worth putting up for consideration. Draken Bowser ( talk) 18:40, 26 March 2024 (UTC)
- Thank you for the feedback
Draken Bowser. I've taken a stab at implementing your suggestions. I'm not sure the Gleason grading paragraph is quite right yet, and would appreciate if you could take a look and let me know what you think.
Ajpolino (
talk) 20:51, 27 March 2024 (UTC)
- I'm not sure either, but since I have no more substantial concerns, as far as I'm concerned, we're done here. Support. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- Thank you for the feedback
Draken Bowser. I've taken a stab at implementing your suggestions. I'm not sure the Gleason grading paragraph is quite right yet, and would appreciate if you could take a look and let me know what you think.
Ajpolino (
talk) 20:51, 27 March 2024 (UTC)
Source review
I'm willing to do a source review, but I'd need a copy of Rebello . Draken Bowser ( talk) 17:02, 15 April 2024 (UTC)
- Thanks very much Draken Bowser. Just emailed you a OneDrive link. Let me know if there's anything else I can send along to help. Ajpolino ( talk) 17:19, 15 April 2024 (UTC)
- Spot check
- 1 30 38 39 44 60 69 78 82 93 127.
- 30: after reading the source several times I'm now convinced that it supports this claim. No wonder it is hard to make this make sense if professionals in peer reviewed journals are struggling. Should we add "Gleason patterns", or just cite the generic "Epstein 2018" (as one footnote) since the information is scattered under three headings.
- 82 very close to the source, but I don't think there's necessarily a simple way to rephrase this, so it might not meet the threshold for creativity?
- 127 while true, shouldn't we stress that GEMMs have mostly supplanted older methods at this point?
- Yes, good point. I've just removed the chemical induced bit. If you think another sentence on mouse models is due, let me know and I'll happily generate one from the source. I'm not sure if your comment was also referring to PDX models. They've remained very common in the prostate cancer research world, particularly for testing therapeutic molecules. I'm not sure why the GEMMs haven't more fully supplanted them.
Ajpolino (
talk) 21:14, 15 April 2024 (UTC)
- Nah, I like this solution. Less is more. /DB
- Yes, good point. I've just removed the chemical induced bit. If you think another sentence on mouse models is due, let me know and I'll happily generate one from the source. I'm not sure if your comment was also referring to PDX models. They've remained very common in the prostate cancer research world, particularly for testing therapeutic molecules. I'm not sure why the GEMMs haven't more fully supplanted them.
Ajpolino (
talk) 21:14, 15 April 2024 (UTC)
- 38, 44, 60 & 93 on hold while I figure out why I can't access it via the uni library, which it says I should be able to.
Notes 1, 39, 69 & 78 raised no concerns. Draken Bowser ( talk) 20:12, 15 April 2024 (UTC)
This is gonna be a bit confused, because I forgot that the combination of two notes moved all others down a notch. I will from now on refer to the current (new) numbers.
- 43 & 44: the source says "into the prostate" and my clinical decision aid says "directly into the prostate gland", I think near the lesions would be correct though.
- Changed to "into the prostate".
- 37b these intervals seem to reflect clinical practice, but I couldn't find them in the source.
- Must've got my wires crossed somehow. Replaced with the correct source.
Notes 59 & 92 raised no concerns. Draken Bowser ( talk) 17:49, 16 April 2024 (UTC)
- Overall
Could I trouble you to say something about Cold Spring Harb Perspect Med and Cureus? I'm not familiar with them. Draken Bowser ( talk) 18:09, 16 April 2024 (UTC)
- Sure, Cold Spring Harbor Perspectives in Medicine is published by Cold Spring Harbor Laboratory Press, the publishing arm of the non-profit molecular biology research institute Cold Spring Harbor Laboratory. They publish nine journals, which are probably of mid-tier impact. Their two "Perspectives in..." journals only publish narrative reviews, so they're often useful for crafting Wikipedia articles. The publisher's director is a well known academic editor with a long history in prestigious science publishing. The journal's editorial board is mostly big shots at major research institutions.
- Cureus, I didn't know much about. A quick Google suggests it has a checkered reputation. I struggled to find sources for a "Society and culture" section and may have reached too far. It was only referencing "and social media posts", so I'll remove that. Ajpolino ( talk) 19:04, 16 April 2024 (UTC)
The article cites peer reviewed journals of repute, including top tier journals, and textbooks by established publishers. Thompson was published 17 years ago, which is a bit on the older side, but it's only used to verify content where practice hasn't changed in at least two decades and is unlikely to change in the next few years. It would be preferable to start replacing it, but I'm not gonna demand it. Spot check revealed one instance of very close paraphrasing, but I'm not convinced the sentence paraphrased reached the creative threshold for copyright. Apart from the tiny mistake on brachytherapy probe placement, there were no other discrepancies of concern. I'm going to call this a pass. Draken Bowser ( talk) 20:37, 16 April 2024 (UTC)
Image review
Gotta skip the source review here because it's a medicine article and these need more specialized knowledge than I am comfortable with assessing. With some of these images I wonder if we can source the information they present e.g File:Diagram showing T1-3 stages of prostate cancer CRUK 278.svg. Was File:Verlauf Prostatakrebs 2011-01 Posttherapie-Szintigramm.jpg published anywhere? File:US PC Inc by age 2016.tif seems to imply that the incidence falls off past 75 years - is that correct, and if so, the article should say it. ALT text seems OK. Jo-Jo Eumerus ( talk) 08:22, 1 April 2024 (UTC)
- Could you clarify your concern on sourcing the information the images present? If the image represents data (like the histogram) or comes from elsewhere (like the radiation cartoon) I cite those sources. But for images that don't fall into one of the above categories I think we typically don't attempt to source the underlying information (of course related claims in the text are cited). The image you mention as an example comes from Cancer Research UK. They've since made a slightly tweaked version which they display on their website. I could add a link to it to the file's description page?
- File:Verlauf Prostatakrebs 2011-01 Posttherapie-Szintigramm.jpg has not been published to my knowledge. It was uploaded to Commons by a user who has uploaded numerous radiology images. I have assumed the user is a radiologist and is the copyright holder for those images. We host many such images at Commons and here on our articles, so I assume it's settled that a radiologist is considered the "photographer" of the images (s)he takes. But I can look into those assumptions if you have a concern.
-
File:US PC Inc by age 2016.tif I believe incidence falls because it's rare for men over aged 75 or so to be screened for prostate cancer -- the rationale being that the disease progresses so slowly that they're unlikely to die from prostate cancer before (sadly) something else takes them. I'm not sure I'll be able to find a source that clearly says "incidence falls for this reason" (though I will look presently!) but I can at least add mention of this in the screening section. Most national medical guidelines set an explicit upper age limit on screening recommendations.
- Didn't yet find a source that clearly addresses this, but CRUK gives a general note alongside their UK prostate cancer incidence data: "A drop or plateau in incidence in the oldest age groups often indicates reduced diagnostic activity perhaps due to general ill health." Not exactly definitive, but again suggests the drop in that graph is due to diagnosis. Ajpolino ( talk) 19:54, 1 April 2024 (UTC)
-
Done.
Ajpolino (
talk) 20:24, 1 April 2024 (UTC)
- The bigger worry is that the article seems to say the opposite (i.e that incidence grows). Someone reading text and image may be confused.
Jo-Jo Eumerus (
talk) 09:08, 2 April 2024 (UTC)
- Hmm, I've added an
explanatory footnote to that image caption. Does that address your concern?
Ajpolino (
talk) 14:47, 2 April 2024 (UTC)
- I guess. Jo-Jo Eumerus ( talk) 16:07, 2 April 2024 (UTC)
- Hmm, I've added an
explanatory footnote to that image caption. Does that address your concern?
Ajpolino (
talk) 14:47, 2 April 2024 (UTC)
- The bigger worry is that the article seems to say the opposite (i.e that incidence grows). Someone reading text and image may be confused.
Jo-Jo Eumerus (
talk) 09:08, 2 April 2024 (UTC)
- Sorry for the lengthy responses to your simple questions. Thank you for taking the time to review the images. Ajpolino ( talk) 19:20, 1 April 2024 (UTC)
- Hi
Jo-Jo, any comebacks? Cheers.
Gog the Mild (
talk) 16:54, 20 April 2024 (UTC)
- No, don't think so. Jo-Jo Eumerus ( talk) 07:13, 21 April 2024 (UTC)
SandyGeorgia
So happy to see this here; what a fine job you've done! Expect to support after I've had time to catch up here with nitpicks.
- A score of 7 (Gleason scores 4 + 3) can be grade group 2 or 3 – grade group 2 if the less severe Gleason score (3) covered more area; grade group 3 if the more severe Gleason score (4) covered more area. A score of 8 is grade group 4. A score of 9 or 10 is grade group 5 (worst prognosis).[28]
- Things might have changed since my husband's prostate cancer, but isn't a Gleason 7 expressed as either a 4 + 3 or a 3 + 4, with the most prominent first, and would adding that info/distinction help explain the difference in grade group? Also, maybe replace the endash to make the whole construct less confusing? That is:
- A score of 7 (with Gleason scores 4 + 3, or Gleason scores 3 + 4, with the most prominent listed first) can be grade group 2 or 3; it is grade group 2 if the less severe Gleason score (3) covered more area; grade group 3 if the more severe Gleason score (4) covered more area. A score of 8 is grade group 4. A score of 9 or 10 is grade group 5 (worst prognosis).[28]
- I think this important since there's a significant difference between a 3 + 4 and a 4 + 3, in the sense of it being a dividing line where worry starts. SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- Things might have changed since my husband's prostate cancer, but isn't a Gleason 7 expressed as either a 4 + 3 or a 3 + 4, with the most prominent first, and would adding that info/distinction help explain the difference in grade group? Also, maybe replace the endash to make the whole construct less confusing? That is:
- Vary wording to avoid additionally, additional? "Those with metastatic disease are additionally treated with chemotherapy, as well as additional radiation or other agents to alleviate the symptoms of metastatic tumors."[38] SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- "Throughout the treatment course, blood PSA levels are monitored to assess the effectiveness of treatments, and whether the disease is advancing.[39]" I am unsure of the generalizability of this sentence ... at a top NCCN clinic, my husband's PSA was not re-taken after the biopsy and once the treatment course (radiation) was decided upon, and was not re-taken until some time after treatment was completed. As written, the sentence seems to imply PSA checks are ongoing during radiation treatment.
SandyGeorgia (
Talk) 21:16, 16 April 2024 (UTC)
- It's possible this has changed since your husband's treatment, or maybe the sentence is implying more frequency than intended. The
current NCCN guideline (free, but you have to make a login to view) says "For patients initially treated with intent to cure, serum PSA levels should be measured every 6 to 12 months for the first 5 years and then annually. PSA testing every 3 months may be better for patients at high risk of recurrence... Similarly, after radiotherapy, the monitoring of serum PSA levels is recommended every 6 months for the first 5 years and then annually." (it's page 120 of the PDF; page MS-36 in their numbering scheme). The ACS website I cited says "Doctors tend to follow the PSA levels every few months to look for trends." Do you think I should tweak the wording to clarify the testing frequency?
Ajpolino (
talk) 17:37, 17 April 2024 (UTC)
-
Ajpolino we're both right then ... my husband's radiation treatment was every weekday for one month, and his PSA was first re-tested some weeks after treatment ended. That is, it was not re-tested "throughout the treatment course", and the source doesn't seem to say it should be ??? The source seems to deal more with after treatment than during; I guess that's where my confusion is ?
SandyGeorgia (
Talk) 17:41, 17 April 2024 (UTC)
- Tweaked to "Blood PSA levels are monitored every few months to assess the effectiveness of treatments, and whether the disease is recurring or advancing." Hopefully clearer and more accurate?
Ajpolino (
talk) 17:46, 17 April 2024 (UTC)
- Works for me! SandyGeorgia ( Talk) 17:51, 17 April 2024 (UTC)
- Tweaked to "Blood PSA levels are monitored every few months to assess the effectiveness of treatments, and whether the disease is recurring or advancing." Hopefully clearer and more accurate?
Ajpolino (
talk) 17:46, 17 April 2024 (UTC)
-
Ajpolino we're both right then ... my husband's radiation treatment was every weekday for one month, and his PSA was first re-tested some weeks after treatment ended. That is, it was not re-tested "throughout the treatment course", and the source doesn't seem to say it should be ??? The source seems to deal more with after treatment than during; I guess that's where my confusion is ?
SandyGeorgia (
Talk) 17:41, 17 April 2024 (UTC)
- It's possible this has changed since your husband's treatment, or maybe the sentence is implying more frequency than intended. The
current NCCN guideline (free, but you have to make a login to view) says "For patients initially treated with intent to cure, serum PSA levels should be measured every 6 to 12 months for the first 5 years and then annually. PSA testing every 3 months may be better for patients at high risk of recurrence... Similarly, after radiotherapy, the monitoring of serum PSA levels is recommended every 6 months for the first 5 years and then annually." (it's page 120 of the PDF; page MS-36 in their numbering scheme). The ACS website I cited says "Doctors tend to follow the PSA levels every few months to look for trends." Do you think I should tweak the wording to clarify the testing frequency?
Ajpolino (
talk) 17:37, 17 April 2024 (UTC)
- Vary wording to avoid monitor ... monitor ? "Men diagnosed with low-risk cases of prostate cancer often defer treatment and are monitored regularly for cancer progression by active surveillance, which involves monitoring the tumor for growth at fixed intervals by PSA tests ... " SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- Apologies for throwing this at you without doing the research myself (I could have misremembered this whole thing, so ignore as needed) ...
- "Those with a family history of prostate cancer are more likely to have prostate cancer."
- As I remember, a BRCA mutation in the family also increases risk across genders, so that a family history of BRCA-related breast cancer in the women would also indicate the men need to watch their prostates. And vica-versa. I could have that wrong. SandyGeorgia ( Talk) 21:32, 16 April 2024 (UTC)
- You remember correctly. Inherited variations of BRCA1 and BRCA2 are associated with increased prostate cancer risk, though the risk increase isn't as high as it is for breast cancer. It's currently covered in
Prostate_cancer#Genetics (a subsection of Epidemiology) as "The greatest risk increase is associated with variations in BRCA2 (up to an eight-fold increased risk)..." and "Variants in other genes involved in DNA damage repair have also been associated with an increased risk of developing prostate cancer... including BRCA1..." If you think that's too buried, I could move it to a Causes subsection, have a separate Risk Factors section, or just make the wording a bit punchier. What do you think?
Ajpolino (
talk) 17:43, 17 April 2024 (UTC)
-
Ajpolino, My main concern is that women know to watch their brothers, and men to watch their sisters :) :) There was breast cancer in my husband's family before BRCA testing was known. Methinks it would be optimal to somehow punch up that first sentence "Those with a family history", to reflect that it's not only the men and not only the prostate that increases risk; if there's BRCA breast cancer, need to keep an eye on that in relatives as well, and it goes both ways.
SandyGeorgia (
Talk) 17:55, 17 April 2024 (UTC)
- Punched it up a bit. Emphasized family history of any cancer is a risk, and snuck the word BRCA in there so it'll raise flags for folks who have heard it. It is the most substantial single gene risk factor, so I think it's due. Let me know if you think even more punching is appropriate.
Ajpolino (
talk) 18:50, 17 April 2024 (UTC)
- Excellent! SandyGeorgia ( Talk) 19:03, 17 April 2024 (UTC)
- Punched it up a bit. Emphasized family history of any cancer is a risk, and snuck the word BRCA in there so it'll raise flags for folks who have heard it. It is the most substantial single gene risk factor, so I think it's due. Let me know if you think even more punching is appropriate.
Ajpolino (
talk) 18:50, 17 April 2024 (UTC)
-
Ajpolino, My main concern is that women know to watch their brothers, and men to watch their sisters :) :) There was breast cancer in my husband's family before BRCA testing was known. Methinks it would be optimal to somehow punch up that first sentence "Those with a family history", to reflect that it's not only the men and not only the prostate that increases risk; if there's BRCA breast cancer, need to keep an eye on that in relatives as well, and it goes both ways.
SandyGeorgia (
Talk) 17:55, 17 April 2024 (UTC)
- "Those with a family history of prostate cancer are more likely to have prostate cancer."
- I stumble over "often frequent" ... blood in the urine or semen, or trouble urinating – often frequent urination and slow or weak urine stream. Can we rewrite this whole thing as (or some such):
- As a tumor grows beyond the prostate, it can damage nearby organs, causing erectile dysfunction, blood in the urine or semen, or trouble urinating – commonly including frequent urination and slow or weak urine stream.[4] 21:38, 16 April 2024 (UTC)
- Do a ctrl-f on the word often? I'm stumbling over how often often occurs :)
SandyGeorgia (
Talk) 21:41, 16 April 2024 (UTC)
- Reduced "often"s 36%. Can probably trim a couple more if it's still bothering you.
Ajpolino (
talk) 18:02, 17 April 2024 (UTC)
- Looking fine now, SandyGeorgia ( Talk) 18:03, 17 April 2024 (UTC)
- Reduced "often"s 36%. Can probably trim a couple more if it's still bothering you.
Ajpolino (
talk) 18:02, 17 April 2024 (UTC)
- Why "typically" (which implies there is a third option)? "Those who elect to have therapy typically receive radiation therapy or a prostatectomy." SandyGeorgia ( Talk) 21:58, 16 April 2024 (UTC)
- Radiation (with pros and cons) is discussed. Prostatectomy (with pros and cons) is discussed. But we never get a comparison of the outcomes of the two. (My perhaps dated understanding was that they were about equal in terms of prognosis ... or at least they were in our case, and the NCCN group let us decide which way to go ... but something needs to be said about the relative benefits/outcomes of the two main treatments.) SandyGeorgia ( Talk) 22:04, 16 April 2024 (UTC)
- Is this "average" misplaced? "The average person who dies from prostate cancer is 77." The average age of those who die from prostate cancer is 77 ??
SandyGeorgia (
Talk) 22:07, 16 April 2024 (UTC)
- Changed to your wording. Not sure if you're also curious about the number itself, but yes that's a typical number you see. Idk where the textbook chapter's data came from, but our beloved
SEER program also calculates a median age of 79 at prostate cancer death in their participants.
[5]
Ajpolino (
talk) 18:40, 17 April 2024 (UTC)
- I am not worried about death stats :) :) Thanks, Aj! SandyGeorgia ( Talk) 18:55, 17 April 2024 (UTC)
- Changed to your wording. Not sure if you're also curious about the number itself, but yes that's a typical number you see. Idk where the textbook chapter's data came from, but our beloved
SEER program also calculates a median age of 79 at prostate cancer death in their participants.
[5]
Ajpolino (
talk) 18:40, 17 April 2024 (UTC)
Once you are through my list, I hope we can get both Colin and WhatamIdoing to have a look to assure the bronze star is truly and optimally shiny!!! But I'll leave pinging them 'til you're ready ... SandyGeorgia ( Talk) 22:10, 16 April 2024 (UTC)
- Actioned your first set of comments above. Thank you for taking the time to go through the article. It is, as always, much improved for your feedback. Ajpolino ( talk) 18:51, 17 April 2024 (UTC)
- I am at a support for Ajpolino's fine work, but because I was once accused of COI and reverted when removing dated and inaccurate information from a prostate-cancer-related article, I alert the FAC Coords to the need to weight my support accordingly if they believe my prior involvement, and my husband having prostate cancer, constitutes a troubling COI. @ Colin and WhatamIdoing: this FAC is maturing to promotion, Graham has been through already, Hog Farm has given a layperson review, it has had a source and image review, and your once over and feedback could make it a truly shiny star! SandyGeorgia ( Talk) 18:54, 17 April 2024 (UTC)
Drive-by comments
- Several works need page ranges. Eg Dall'Era; Pilié et al; Stephenson; and others.
- Added page numbers for Stephenson and Valier.
- Dall'Era; Hessen; Pilié et al; Scher and Eastham are online resources and are not paginated.
- Coleman et al; Mai et al; Pernar et al; Rebello et al are online-only and give a single "page" number that identifies the document
- "Most men are diagnosed with tumors confined to the prostate"! Suggest 'Most men diagnosed have tumors confined to the prostate' or similar.
- Oops! Went with your suggestion.
- "Tumors that have metastasized". "metastasized" - why use "spread" at first mention and the unlinked, unexplained technical term at second?
- Good point. Changed first to " metastasize (spread)" but am open to a more thorough rewording if you think it would help.
- "As surgery became more common, prostate tumors were found". Perhaps 'more prostate tumors' or 'many prostate tumors' or 'increasing numbers of prostate tumors' or similar?
Gog the Mild (
talk) 16:25, 22 April 2024 (UTC)
- Went with "more" to keep it short and sweet.
Thank you for taking the time to leave comments. Happy to take any others. Ajpolino ( talk) 18:22, 22 April 2024 (UTC)
- Also, Dall'Era, or Stephenson, for example, do specify in which section material occurs which is OK for online sources without page nos. SandyGeorgia ( Talk) 18:42, 22 April 2024 (UTC)
- Closing note: This candidate has been promoted, but there may be a delay in bot processing of the close. Please see WP:FAC/ar, and leave the {{ featured article candidates}} template in place on the talk page until the bot goes through. Gog the Mild ( talk) 19:10, 22 April 2024 (UTC)
- The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
- The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.
The article was promoted by Gog the Mild via FACBot ( talk) 22 April 2024 [1].
Prostate cancer
In 1 in 8 men, some cells in a small gland beneath the bladder go haywire. They grow and grow, eschewing the checks meant to bind them in place, and evading the ever-watchful immune system. Some split off the growing tumor, settling most often in nearby bones. In their race to grow, they digest the bone beneath them, causing excruciating pain and bone fractures. 350,000 men succumb to the disease each year, making prostate cancer the second deadliest cancer in men (after lung cancer, the subject of a 2023 FAR). Many thanks to SandyGeorgia, Colin, and Femke for shaping the article with their suggestions and feedback. My intention is that the article be clear to the medicine-literate and medicine-uninitiated alike, so please have a look and let me know what you think. Ajpolino ( talk) 20:00, 21 March 2024 (UTC)
- Former featured article: Reminder to update the page and numbers at
WP:FFA upon promotion.
SandyGeorgia (
Talk) 14:48, 17 April 2024 (UTC)
- Done, thanks Gog and DrKay! SandyGeorgia ( Talk) 20:32, 22 April 2024 (UTC)
Graham Beards
Support My (few) comments were addressed on the article's Talk Page along with more extensive ones from other reviewers. In my view, this is a well written and well referenced medical article. I made a few very minor edits today for the nominator's consideration. Graham Beards ( talk) 12:55, 22 March 2024 (UTC)
- Comment: how well-covered in medical literature is the topic of prostate cancer in
trans women? I see a couple sources from a quick Google search
[2]
[3]
[4].
Elias 🪐 (dreaming of Saturn;
talk here) 08:56, 22 March 2024 (UTC)
- Good point. It's well enough covered that we should have something in the article. I'll add a bit.
Ajpolino (
talk) 11:50, 22 March 2024 (UTC)
- I've added a short paragraph. Pardon the clunky euphemism "Special populations", it's a
MEDMOS suggestion. If folks prefer, we could swap it for a more direct heading like "Transgender women" or "Transgender populations". Or the info could be split up into the article sections each fact corresponds to.
Ajpolino (
talk) 20:04, 22 March 2024 (UTC)
- Thank you; I believe the current amount of information you've added is sufficient given the research around transgender people in medical contexts is still pretty recent. I think I prefer the last approach @ Ajpolino, as having a dedicated section singles them out and would probably be frowned upon by our trans laypeople readers. Of course, I would like the opinions of other, more experienced medical editors in this regard if ever anyone disagrees with me. Elias 🪐 (dreaming of Saturn; talk here) 02:42, 26 March 2024 (UTC)
- I've added a short paragraph. Pardon the clunky euphemism "Special populations", it's a
MEDMOS suggestion. If folks prefer, we could swap it for a more direct heading like "Transgender women" or "Transgender populations". Or the info could be split up into the article sections each fact corresponds to.
Ajpolino (
talk) 20:04, 22 March 2024 (UTC)
- Good point. It's well enough covered that we should have something in the article. I'll add a bit.
Ajpolino (
talk) 11:50, 22 March 2024 (UTC)
HF
I'm not familiar at all with medical stuff, but will try to review this over the weekend. Hog Farm Talk 13:11, 22 March 2024 (UTC)
- "The sum of the most common two assigned numbers is the "Gleason score".[27] Gleason scores of 2 through 5 are no longer commonly used in practice, making the lowest Gleason score 6, and the highest 10. " - this doesn't entirely make sense to me. Is this saying that, for instance, a score of 2 and 3 is unlikely to come up?
- I've rephrased this paragraph since Femke and Draken Bowser both found it unclear as well. Take a look and see what you think. I've added a footnote to answer your exact question. In short, it's a historical quirk. The "Gleason grade group" system (with grade groups 1-5) is meant to eventually replace the Gleason score. The old Gleason score system had scores 2–10; the current one has scores 6–10, and is living alongside its successor that runs 1–5. Despite both being five-point scales, the current 6–10 score doesn't map perfectly onto the successor 1–5 scale. I'm having trouble clearly communicating that part, so if you have any suggestions I'm all ears. Ajpolino ( talk) 19:46, 27 March 2024 (UTC)
- " called castration-resistant prostate cancer (CRPC)" - does this imply that castration is a potential treatment for this cancer? This appears to be discussed a bit in the history section, but the discussions on treatment leave this question unanswered
- In medical jargon land, we call
removing your testicles "surgical castration" and eliminating your body's testosterone
with drugs "chemical castration". I've added
(also called "chemical castration")
to the first mention of the treatment. Do you think that would suffice to reduce a reader's surprise when they make it to "castration-resistant"? To your direct question, surgical castration is still occasionally used for prostate cancer, but its use is declining (3.5% and falling as of 2016). Most recent sources only mention it in passing if at all, noting only that patients tend not to choose it. As such, I haven't covered it in the article, but certainly could add a couple sentences if you think it would be helpful context.
- In medical jargon land, we call
removing your testicles "surgical castration" and eliminating your body's testosterone
with drugs "chemical castration". I've added
- "Depends on stage, five-year survival rate 97%" - if this is important enough for the infobox, should it be in the body of the article as well?
Excellent work; I expect to support. It perhaps says something that I have no issues writing content about horrible Civil War combat, but I spend most of the read-through of this article shuddering in horror. Hog Farm Talk 00:33, 27 March 2024 (UTC)
- Thanks much for your time and feedback. I'm gratified that the article elicited any response besides boredom. FWIW, a glance at American Civil War's infobox suggests your chance of surviving a bout with prostate cancer (as one or both of us might) are better than a man's chance of making it through the war alive. Not sure if that reflects more positively on the prostate cancer experience, or negatively on the Civil War experience. Probably the latter. Ajpolino ( talk) 21:31, 27 March 2024 (UTC)
Support from Femke
As I said at the end of my GA review, I believe the article now meets the FA criteria. —Femke 🐦 ( talk) 16:45, 22 March 2024 (UTC)
Support from Draken Bowser
Just like the new and improved lung cancer i find that the article is readable and offers a nice balance between completeness and conciseness. I have but a few suggestions:
- "Men with high PSA levels are often recommended to repeat the blood test four to six weeks later, as PSA levels can fluctuate unrelated to prostate cancer." I think it's perhaps of more interest to mention how PSA-levels spike in response to
UTI:s and
urinary retention, or do both sentences.
- Recent reviews seem not to mention UTIs and urinary retention as PSA raisers, any idea why? I'm not familiar enough with the field to know. Carlsson 2021 mentions only BPH; the Harrison's chapter I use heavily mentions only prostatitis and BPH (Scher 2022); Rebello 2021 mentions only prostatitis and BPH; public-facing CDC site gives "certain" procedures/medications, BPH, and infection; similar ACS site gives a longer list but no UTI. To your more general point I've added two short sentences on what can raise and lower PSA levels. Hope you feel that improves things. Ajpolino ( talk) 18:28, 27 March 2024 (UTC)
- No idea why, in clinical practice I've regularly seen spikes above 20 in patients with a recent UTI, which then recedes to a baseline of ~1,5 within 2–3 months (just to be clear, I'm not the bozo ordering these PSA-tests :P). Maybe it's the good old case of experts refusing to repeat the obvious. Looks good now. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- "...and lead to unneeded biopsies and treatments." I think this sentence should also follow up with the word "complications", to stress clearly that it is not only an issue of resource allocation and mental health, but something that carries a risk of physical health issues. This is of course already explained elsewhere, but I'd still make the addition here.
- My brain shuts down trying to read the section on Gleason scores. While I'm not a native speaker I'm also concerned there is an accessibility issue.
- Femke had a similar concern at GAN, and I see it was unclear to Hog Farm above as well. I've tried some editing to hopefully clarify. Is it any better? I'm not sure how to clearly phrase the part about Gleason scores of 7 being converted into Gleason grade group 2 or 3. The fact that there's so many numbers named Gleason makes it challenging to communicate clearly.
- Yeah, it's better and the efn is a nice touch. If I get any ideas on further improvements I'll get back to you. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- I think the article should briefly discuss pre-biopsy MRI.
That's all and once again, excellent work. Draken Bowser ( talk) 17:16, 26 March 2024 (UTC)
- Oh and one more thing. The section on radiotherapy mentions the diagnosis bladder cancer as a complication, but lists only symptoms related to radiation proctitis, without mentioning the diagnosis by name. I'm not sure if adding it is an improvement, but I thought it was worth putting up for consideration. Draken Bowser ( talk) 18:40, 26 March 2024 (UTC)
- Thank you for the feedback
Draken Bowser. I've taken a stab at implementing your suggestions. I'm not sure the Gleason grading paragraph is quite right yet, and would appreciate if you could take a look and let me know what you think.
Ajpolino (
talk) 20:51, 27 March 2024 (UTC)
- I'm not sure either, but since I have no more substantial concerns, as far as I'm concerned, we're done here. Support. Draken Bowser ( talk) 21:19, 27 March 2024 (UTC)
- Thank you for the feedback
Draken Bowser. I've taken a stab at implementing your suggestions. I'm not sure the Gleason grading paragraph is quite right yet, and would appreciate if you could take a look and let me know what you think.
Ajpolino (
talk) 20:51, 27 March 2024 (UTC)
Source review
I'm willing to do a source review, but I'd need a copy of Rebello . Draken Bowser ( talk) 17:02, 15 April 2024 (UTC)
- Thanks very much Draken Bowser. Just emailed you a OneDrive link. Let me know if there's anything else I can send along to help. Ajpolino ( talk) 17:19, 15 April 2024 (UTC)
- Spot check
- 1 30 38 39 44 60 69 78 82 93 127.
- 30: after reading the source several times I'm now convinced that it supports this claim. No wonder it is hard to make this make sense if professionals in peer reviewed journals are struggling. Should we add "Gleason patterns", or just cite the generic "Epstein 2018" (as one footnote) since the information is scattered under three headings.
- 82 very close to the source, but I don't think there's necessarily a simple way to rephrase this, so it might not meet the threshold for creativity?
- 127 while true, shouldn't we stress that GEMMs have mostly supplanted older methods at this point?
- Yes, good point. I've just removed the chemical induced bit. If you think another sentence on mouse models is due, let me know and I'll happily generate one from the source. I'm not sure if your comment was also referring to PDX models. They've remained very common in the prostate cancer research world, particularly for testing therapeutic molecules. I'm not sure why the GEMMs haven't more fully supplanted them.
Ajpolino (
talk) 21:14, 15 April 2024 (UTC)
- Nah, I like this solution. Less is more. /DB
- Yes, good point. I've just removed the chemical induced bit. If you think another sentence on mouse models is due, let me know and I'll happily generate one from the source. I'm not sure if your comment was also referring to PDX models. They've remained very common in the prostate cancer research world, particularly for testing therapeutic molecules. I'm not sure why the GEMMs haven't more fully supplanted them.
Ajpolino (
talk) 21:14, 15 April 2024 (UTC)
- 38, 44, 60 & 93 on hold while I figure out why I can't access it via the uni library, which it says I should be able to.
Notes 1, 39, 69 & 78 raised no concerns. Draken Bowser ( talk) 20:12, 15 April 2024 (UTC)
This is gonna be a bit confused, because I forgot that the combination of two notes moved all others down a notch. I will from now on refer to the current (new) numbers.
- 43 & 44: the source says "into the prostate" and my clinical decision aid says "directly into the prostate gland", I think near the lesions would be correct though.
- Changed to "into the prostate".
- 37b these intervals seem to reflect clinical practice, but I couldn't find them in the source.
- Must've got my wires crossed somehow. Replaced with the correct source.
Notes 59 & 92 raised no concerns. Draken Bowser ( talk) 17:49, 16 April 2024 (UTC)
- Overall
Could I trouble you to say something about Cold Spring Harb Perspect Med and Cureus? I'm not familiar with them. Draken Bowser ( talk) 18:09, 16 April 2024 (UTC)
- Sure, Cold Spring Harbor Perspectives in Medicine is published by Cold Spring Harbor Laboratory Press, the publishing arm of the non-profit molecular biology research institute Cold Spring Harbor Laboratory. They publish nine journals, which are probably of mid-tier impact. Their two "Perspectives in..." journals only publish narrative reviews, so they're often useful for crafting Wikipedia articles. The publisher's director is a well known academic editor with a long history in prestigious science publishing. The journal's editorial board is mostly big shots at major research institutions.
- Cureus, I didn't know much about. A quick Google suggests it has a checkered reputation. I struggled to find sources for a "Society and culture" section and may have reached too far. It was only referencing "and social media posts", so I'll remove that. Ajpolino ( talk) 19:04, 16 April 2024 (UTC)
The article cites peer reviewed journals of repute, including top tier journals, and textbooks by established publishers. Thompson was published 17 years ago, which is a bit on the older side, but it's only used to verify content where practice hasn't changed in at least two decades and is unlikely to change in the next few years. It would be preferable to start replacing it, but I'm not gonna demand it. Spot check revealed one instance of very close paraphrasing, but I'm not convinced the sentence paraphrased reached the creative threshold for copyright. Apart from the tiny mistake on brachytherapy probe placement, there were no other discrepancies of concern. I'm going to call this a pass. Draken Bowser ( talk) 20:37, 16 April 2024 (UTC)
Image review
Gotta skip the source review here because it's a medicine article and these need more specialized knowledge than I am comfortable with assessing. With some of these images I wonder if we can source the information they present e.g File:Diagram showing T1-3 stages of prostate cancer CRUK 278.svg. Was File:Verlauf Prostatakrebs 2011-01 Posttherapie-Szintigramm.jpg published anywhere? File:US PC Inc by age 2016.tif seems to imply that the incidence falls off past 75 years - is that correct, and if so, the article should say it. ALT text seems OK. Jo-Jo Eumerus ( talk) 08:22, 1 April 2024 (UTC)
- Could you clarify your concern on sourcing the information the images present? If the image represents data (like the histogram) or comes from elsewhere (like the radiation cartoon) I cite those sources. But for images that don't fall into one of the above categories I think we typically don't attempt to source the underlying information (of course related claims in the text are cited). The image you mention as an example comes from Cancer Research UK. They've since made a slightly tweaked version which they display on their website. I could add a link to it to the file's description page?
- File:Verlauf Prostatakrebs 2011-01 Posttherapie-Szintigramm.jpg has not been published to my knowledge. It was uploaded to Commons by a user who has uploaded numerous radiology images. I have assumed the user is a radiologist and is the copyright holder for those images. We host many such images at Commons and here on our articles, so I assume it's settled that a radiologist is considered the "photographer" of the images (s)he takes. But I can look into those assumptions if you have a concern.
-
File:US PC Inc by age 2016.tif I believe incidence falls because it's rare for men over aged 75 or so to be screened for prostate cancer -- the rationale being that the disease progresses so slowly that they're unlikely to die from prostate cancer before (sadly) something else takes them. I'm not sure I'll be able to find a source that clearly says "incidence falls for this reason" (though I will look presently!) but I can at least add mention of this in the screening section. Most national medical guidelines set an explicit upper age limit on screening recommendations.
- Didn't yet find a source that clearly addresses this, but CRUK gives a general note alongside their UK prostate cancer incidence data: "A drop or plateau in incidence in the oldest age groups often indicates reduced diagnostic activity perhaps due to general ill health." Not exactly definitive, but again suggests the drop in that graph is due to diagnosis. Ajpolino ( talk) 19:54, 1 April 2024 (UTC)
-
Done.
Ajpolino (
talk) 20:24, 1 April 2024 (UTC)
- The bigger worry is that the article seems to say the opposite (i.e that incidence grows). Someone reading text and image may be confused.
Jo-Jo Eumerus (
talk) 09:08, 2 April 2024 (UTC)
- Hmm, I've added an
explanatory footnote to that image caption. Does that address your concern?
Ajpolino (
talk) 14:47, 2 April 2024 (UTC)
- I guess. Jo-Jo Eumerus ( talk) 16:07, 2 April 2024 (UTC)
- Hmm, I've added an
explanatory footnote to that image caption. Does that address your concern?
Ajpolino (
talk) 14:47, 2 April 2024 (UTC)
- The bigger worry is that the article seems to say the opposite (i.e that incidence grows). Someone reading text and image may be confused.
Jo-Jo Eumerus (
talk) 09:08, 2 April 2024 (UTC)
- Sorry for the lengthy responses to your simple questions. Thank you for taking the time to review the images. Ajpolino ( talk) 19:20, 1 April 2024 (UTC)
- Hi
Jo-Jo, any comebacks? Cheers.
Gog the Mild (
talk) 16:54, 20 April 2024 (UTC)
- No, don't think so. Jo-Jo Eumerus ( talk) 07:13, 21 April 2024 (UTC)
SandyGeorgia
So happy to see this here; what a fine job you've done! Expect to support after I've had time to catch up here with nitpicks.
- A score of 7 (Gleason scores 4 + 3) can be grade group 2 or 3 – grade group 2 if the less severe Gleason score (3) covered more area; grade group 3 if the more severe Gleason score (4) covered more area. A score of 8 is grade group 4. A score of 9 or 10 is grade group 5 (worst prognosis).[28]
- Things might have changed since my husband's prostate cancer, but isn't a Gleason 7 expressed as either a 4 + 3 or a 3 + 4, with the most prominent first, and would adding that info/distinction help explain the difference in grade group? Also, maybe replace the endash to make the whole construct less confusing? That is:
- A score of 7 (with Gleason scores 4 + 3, or Gleason scores 3 + 4, with the most prominent listed first) can be grade group 2 or 3; it is grade group 2 if the less severe Gleason score (3) covered more area; grade group 3 if the more severe Gleason score (4) covered more area. A score of 8 is grade group 4. A score of 9 or 10 is grade group 5 (worst prognosis).[28]
- I think this important since there's a significant difference between a 3 + 4 and a 4 + 3, in the sense of it being a dividing line where worry starts. SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- Things might have changed since my husband's prostate cancer, but isn't a Gleason 7 expressed as either a 4 + 3 or a 3 + 4, with the most prominent first, and would adding that info/distinction help explain the difference in grade group? Also, maybe replace the endash to make the whole construct less confusing? That is:
- Vary wording to avoid additionally, additional? "Those with metastatic disease are additionally treated with chemotherapy, as well as additional radiation or other agents to alleviate the symptoms of metastatic tumors."[38] SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- "Throughout the treatment course, blood PSA levels are monitored to assess the effectiveness of treatments, and whether the disease is advancing.[39]" I am unsure of the generalizability of this sentence ... at a top NCCN clinic, my husband's PSA was not re-taken after the biopsy and once the treatment course (radiation) was decided upon, and was not re-taken until some time after treatment was completed. As written, the sentence seems to imply PSA checks are ongoing during radiation treatment.
SandyGeorgia (
Talk) 21:16, 16 April 2024 (UTC)
- It's possible this has changed since your husband's treatment, or maybe the sentence is implying more frequency than intended. The
current NCCN guideline (free, but you have to make a login to view) says "For patients initially treated with intent to cure, serum PSA levels should be measured every 6 to 12 months for the first 5 years and then annually. PSA testing every 3 months may be better for patients at high risk of recurrence... Similarly, after radiotherapy, the monitoring of serum PSA levels is recommended every 6 months for the first 5 years and then annually." (it's page 120 of the PDF; page MS-36 in their numbering scheme). The ACS website I cited says "Doctors tend to follow the PSA levels every few months to look for trends." Do you think I should tweak the wording to clarify the testing frequency?
Ajpolino (
talk) 17:37, 17 April 2024 (UTC)
-
Ajpolino we're both right then ... my husband's radiation treatment was every weekday for one month, and his PSA was first re-tested some weeks after treatment ended. That is, it was not re-tested "throughout the treatment course", and the source doesn't seem to say it should be ??? The source seems to deal more with after treatment than during; I guess that's where my confusion is ?
SandyGeorgia (
Talk) 17:41, 17 April 2024 (UTC)
- Tweaked to "Blood PSA levels are monitored every few months to assess the effectiveness of treatments, and whether the disease is recurring or advancing." Hopefully clearer and more accurate?
Ajpolino (
talk) 17:46, 17 April 2024 (UTC)
- Works for me! SandyGeorgia ( Talk) 17:51, 17 April 2024 (UTC)
- Tweaked to "Blood PSA levels are monitored every few months to assess the effectiveness of treatments, and whether the disease is recurring or advancing." Hopefully clearer and more accurate?
Ajpolino (
talk) 17:46, 17 April 2024 (UTC)
-
Ajpolino we're both right then ... my husband's radiation treatment was every weekday for one month, and his PSA was first re-tested some weeks after treatment ended. That is, it was not re-tested "throughout the treatment course", and the source doesn't seem to say it should be ??? The source seems to deal more with after treatment than during; I guess that's where my confusion is ?
SandyGeorgia (
Talk) 17:41, 17 April 2024 (UTC)
- It's possible this has changed since your husband's treatment, or maybe the sentence is implying more frequency than intended. The
current NCCN guideline (free, but you have to make a login to view) says "For patients initially treated with intent to cure, serum PSA levels should be measured every 6 to 12 months for the first 5 years and then annually. PSA testing every 3 months may be better for patients at high risk of recurrence... Similarly, after radiotherapy, the monitoring of serum PSA levels is recommended every 6 months for the first 5 years and then annually." (it's page 120 of the PDF; page MS-36 in their numbering scheme). The ACS website I cited says "Doctors tend to follow the PSA levels every few months to look for trends." Do you think I should tweak the wording to clarify the testing frequency?
Ajpolino (
talk) 17:37, 17 April 2024 (UTC)
- Vary wording to avoid monitor ... monitor ? "Men diagnosed with low-risk cases of prostate cancer often defer treatment and are monitored regularly for cancer progression by active surveillance, which involves monitoring the tumor for growth at fixed intervals by PSA tests ... " SandyGeorgia ( Talk) 21:16, 16 April 2024 (UTC)
- Apologies for throwing this at you without doing the research myself (I could have misremembered this whole thing, so ignore as needed) ...
- "Those with a family history of prostate cancer are more likely to have prostate cancer."
- As I remember, a BRCA mutation in the family also increases risk across genders, so that a family history of BRCA-related breast cancer in the women would also indicate the men need to watch their prostates. And vica-versa. I could have that wrong. SandyGeorgia ( Talk) 21:32, 16 April 2024 (UTC)
- You remember correctly. Inherited variations of BRCA1 and BRCA2 are associated with increased prostate cancer risk, though the risk increase isn't as high as it is for breast cancer. It's currently covered in
Prostate_cancer#Genetics (a subsection of Epidemiology) as "The greatest risk increase is associated with variations in BRCA2 (up to an eight-fold increased risk)..." and "Variants in other genes involved in DNA damage repair have also been associated with an increased risk of developing prostate cancer... including BRCA1..." If you think that's too buried, I could move it to a Causes subsection, have a separate Risk Factors section, or just make the wording a bit punchier. What do you think?
Ajpolino (
talk) 17:43, 17 April 2024 (UTC)
-
Ajpolino, My main concern is that women know to watch their brothers, and men to watch their sisters :) :) There was breast cancer in my husband's family before BRCA testing was known. Methinks it would be optimal to somehow punch up that first sentence "Those with a family history", to reflect that it's not only the men and not only the prostate that increases risk; if there's BRCA breast cancer, need to keep an eye on that in relatives as well, and it goes both ways.
SandyGeorgia (
Talk) 17:55, 17 April 2024 (UTC)
- Punched it up a bit. Emphasized family history of any cancer is a risk, and snuck the word BRCA in there so it'll raise flags for folks who have heard it. It is the most substantial single gene risk factor, so I think it's due. Let me know if you think even more punching is appropriate.
Ajpolino (
talk) 18:50, 17 April 2024 (UTC)
- Excellent! SandyGeorgia ( Talk) 19:03, 17 April 2024 (UTC)
- Punched it up a bit. Emphasized family history of any cancer is a risk, and snuck the word BRCA in there so it'll raise flags for folks who have heard it. It is the most substantial single gene risk factor, so I think it's due. Let me know if you think even more punching is appropriate.
Ajpolino (
talk) 18:50, 17 April 2024 (UTC)
-
Ajpolino, My main concern is that women know to watch their brothers, and men to watch their sisters :) :) There was breast cancer in my husband's family before BRCA testing was known. Methinks it would be optimal to somehow punch up that first sentence "Those with a family history", to reflect that it's not only the men and not only the prostate that increases risk; if there's BRCA breast cancer, need to keep an eye on that in relatives as well, and it goes both ways.
SandyGeorgia (
Talk) 17:55, 17 April 2024 (UTC)
- "Those with a family history of prostate cancer are more likely to have prostate cancer."
- I stumble over "often frequent" ... blood in the urine or semen, or trouble urinating – often frequent urination and slow or weak urine stream. Can we rewrite this whole thing as (or some such):
- As a tumor grows beyond the prostate, it can damage nearby organs, causing erectile dysfunction, blood in the urine or semen, or trouble urinating – commonly including frequent urination and slow or weak urine stream.[4] 21:38, 16 April 2024 (UTC)
- Do a ctrl-f on the word often? I'm stumbling over how often often occurs :)
SandyGeorgia (
Talk) 21:41, 16 April 2024 (UTC)
- Reduced "often"s 36%. Can probably trim a couple more if it's still bothering you.
Ajpolino (
talk) 18:02, 17 April 2024 (UTC)
- Looking fine now, SandyGeorgia ( Talk) 18:03, 17 April 2024 (UTC)
- Reduced "often"s 36%. Can probably trim a couple more if it's still bothering you.
Ajpolino (
talk) 18:02, 17 April 2024 (UTC)
- Why "typically" (which implies there is a third option)? "Those who elect to have therapy typically receive radiation therapy or a prostatectomy." SandyGeorgia ( Talk) 21:58, 16 April 2024 (UTC)
- Radiation (with pros and cons) is discussed. Prostatectomy (with pros and cons) is discussed. But we never get a comparison of the outcomes of the two. (My perhaps dated understanding was that they were about equal in terms of prognosis ... or at least they were in our case, and the NCCN group let us decide which way to go ... but something needs to be said about the relative benefits/outcomes of the two main treatments.) SandyGeorgia ( Talk) 22:04, 16 April 2024 (UTC)
- Is this "average" misplaced? "The average person who dies from prostate cancer is 77." The average age of those who die from prostate cancer is 77 ??
SandyGeorgia (
Talk) 22:07, 16 April 2024 (UTC)
- Changed to your wording. Not sure if you're also curious about the number itself, but yes that's a typical number you see. Idk where the textbook chapter's data came from, but our beloved
SEER program also calculates a median age of 79 at prostate cancer death in their participants.
[5]
Ajpolino (
talk) 18:40, 17 April 2024 (UTC)
- I am not worried about death stats :) :) Thanks, Aj! SandyGeorgia ( Talk) 18:55, 17 April 2024 (UTC)
- Changed to your wording. Not sure if you're also curious about the number itself, but yes that's a typical number you see. Idk where the textbook chapter's data came from, but our beloved
SEER program also calculates a median age of 79 at prostate cancer death in their participants.
[5]
Ajpolino (
talk) 18:40, 17 April 2024 (UTC)
Once you are through my list, I hope we can get both Colin and WhatamIdoing to have a look to assure the bronze star is truly and optimally shiny!!! But I'll leave pinging them 'til you're ready ... SandyGeorgia ( Talk) 22:10, 16 April 2024 (UTC)
- Actioned your first set of comments above. Thank you for taking the time to go through the article. It is, as always, much improved for your feedback. Ajpolino ( talk) 18:51, 17 April 2024 (UTC)
- I am at a support for Ajpolino's fine work, but because I was once accused of COI and reverted when removing dated and inaccurate information from a prostate-cancer-related article, I alert the FAC Coords to the need to weight my support accordingly if they believe my prior involvement, and my husband having prostate cancer, constitutes a troubling COI. @ Colin and WhatamIdoing: this FAC is maturing to promotion, Graham has been through already, Hog Farm has given a layperson review, it has had a source and image review, and your once over and feedback could make it a truly shiny star! SandyGeorgia ( Talk) 18:54, 17 April 2024 (UTC)
Drive-by comments
- Several works need page ranges. Eg Dall'Era; Pilié et al; Stephenson; and others.
- Added page numbers for Stephenson and Valier.
- Dall'Era; Hessen; Pilié et al; Scher and Eastham are online resources and are not paginated.
- Coleman et al; Mai et al; Pernar et al; Rebello et al are online-only and give a single "page" number that identifies the document
- "Most men are diagnosed with tumors confined to the prostate"! Suggest 'Most men diagnosed have tumors confined to the prostate' or similar.
- Oops! Went with your suggestion.
- "Tumors that have metastasized". "metastasized" - why use "spread" at first mention and the unlinked, unexplained technical term at second?
- Good point. Changed first to " metastasize (spread)" but am open to a more thorough rewording if you think it would help.
- "As surgery became more common, prostate tumors were found". Perhaps 'more prostate tumors' or 'many prostate tumors' or 'increasing numbers of prostate tumors' or similar?
Gog the Mild (
talk) 16:25, 22 April 2024 (UTC)
- Went with "more" to keep it short and sweet.
Thank you for taking the time to leave comments. Happy to take any others. Ajpolino ( talk) 18:22, 22 April 2024 (UTC)
- Also, Dall'Era, or Stephenson, for example, do specify in which section material occurs which is OK for online sources without page nos. SandyGeorgia ( Talk) 18:42, 22 April 2024 (UTC)
- Closing note: This candidate has been promoted, but there may be a delay in bot processing of the close. Please see WP:FAC/ar, and leave the {{ featured article candidates}} template in place on the talk page until the bot goes through. Gog the Mild ( talk) 19:10, 22 April 2024 (UTC)
- The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.