Talk:Prostate cancer

Did you know nomination

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

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

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• Comment or view
• Article history

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

Improved to Good Article status by Ajpolino (talk).

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

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

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

General eligibility:

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

Policy compliance:

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

Hook eligibility:

• Cited:
• Interesting:
• Other problems:

QPQ: None required.

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

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

I could maybe see a close paraphrasing issue here but I'll chalk it up to WP:LIMITED since these are simple facts that are hard to reword. I made a few minor tweaks to the lead and to the article to massage out an inconsistency, please review here: [1]. Passing DYK, congrats!! 🏵️Etrius ( Us) 00:45, 25 March 2024 (UTC)

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

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

More comments from Colin

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

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

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

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

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

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

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

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

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

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

Recent changes to section order, et al

Hi Tobiasi0, I'm sorry to have reverted your recent change to the article's section order, et al. Since you've made a bunch of changes at once, it's challenging to see what they all were. This article has recently been reviewed by many eyes as part of the process to be designated a "featured article". That doesn't mean it's perfect, but does suggest perhaps we can proceed a bit more cautiously than with your average article page. Let's discuss the things you wish to change here. We can pull in others to find consensus if needed. I'll highlight the biggest changes for discussion below. Since there were so many changes across the article, I'm sure there are uncontroversial changes I missed, and for that I apologize. Ajpolino (talk) 13:02, 26 May 2024 (UTC)

Thank you for your kind message. I understand that it is difficult to retrace all changes at once, so let me explain my main intentions and changes:

1. Image: I changed the infobox image to a micrograph showing prostate adenocarcinoma because the previous one just shows the anatomical perspective of the prostate rather than the actual disease the article is about. Instead of the micrograph, we could use only the diagram as well to represent the topic adequately. Additionally, I adjusted a few other images to fit better within their sections visually.
2. Introduction: I shortened the introduction by removing the explanation of the prostate, as this is covered in the article "prostate." I deleted the sentence "Early prostate cancer causes no symptoms" because this is stated in the following paragraph: "Most prostate tumors remain small and cause no health problems."
3. Content order: Most disease articles on Wikipedia follow the order: symptoms, causes, pathophysiology, diagnosis, management, prevention, epidemiology, research, history (for example, see allergic rhinitis and multiple sclerosis or more specifically other oncologic diseases such as colorectal cancer or esophageal cancer). While this can vary, symptoms, causes, pathophysiology, diagnosis, and management should remain in this order. The rationale is that most diseases are characterized by symptoms. Next, there are causes and risk factors from which a disease originates. Following this is the mechanism of the disease itself, the pathophysiology, which can be determined by diagnosis. After diagnosis, the disease is treated. Before diagnosis, there are typically preventive measures, including screening, which is the technical assessment of someone's state based on the estimated risk of the person being affected by the disease. After management, a prognosis is given on the likelihood of recovery. Historical and social side facts are typically referred to last. Additionally, I moved the subtopics of epidemiology to causes as they both are formal treatises that cover epidemiological facts just briefly in the background. Technically, prevention, including screening, could be included as part of management as well.

I understand the idea of sorting the contents based on the experience of the patient, but I don't think it is that useful as this article is an encyclopedic article about the disease and not a how-to guide or pamphlet from a cancer support center, which is designed to accompany and inform the affected person in their recovery about their specific course of therapy. Imho, this article should not make a difference between academic and clinical information, following the alignment of most articles about diseases as in the end, cancer is just a disease—a disease requiring specialized personnel, therapy and educational work to create awareness, but still a disease—something that needs to be treated just the same way as any other disease to meet essential rules like neutrality, equality, and the principle of encyclopedic work.

Lastly, I just fixed some links and added them to phrases such as the "uncontrolled growth of cells" in the beginning while spacing the source code to make it more clear and uniform.

I hope, you can understand my rationale for the changes. If you have any additional ideas or concerns, just let me know. –Tobias (talk) 14:02, 26 May 2024 (UTC)

I think we're just going to have to disagree on section order. I feel the old order did a better job of introducing the article and giving it a readable flow. I'm aware that many other articles use the order you're suggesting, as it's the recommended (though not required, of course) order in MEDMOS. But I feel this order is superior for this particular topic, and is also the order that I've used at Lung cancer and Breast cancer. If anyone else is watching this page, their thoughts would certainly be welcome. If not, we can ask for more opinions at WT:MED.

Image - In general, I think the lead image should be understandable (even informative?) to the general reader of the article. I try to avoid histology images as lead images because I imagine they're meaningful to a very very low percentage of readers (some subset of healthcare providers and researchers?). Your idea of just using the tumor cartoon seems good to me. I can redo that and your other image moves this evening, or certainly you're welcome to do so any time.

Intro - That sounds good to me. Same as above, I can redo this evening or you're welcome to. Sorry for undoing the whole thing. With the section order change the diff viewer just showed the whole article as changed and I was having trouble understanding.

With image movements and intro wording, if there's anything else we disagree on, I'm sure it'll be small and we can discuss the particulars. Thank you for your patience, and for your interest in improving the article. Taking a quick, semi-creepy look I can see that your activity has increased substantially the last few months. I hope you decide to stick around. The medicine articles need an absolute ton of work. Medicine-interested editors are a precious resource, and I'm glad to see another one. Best, Ajpolino (talk) 19:24, 26 May 2024 (UTC)

I agree with Ajpolino on the image and the order; it's not strictly required to follow WP:MEDORDER, a suggested guide, and if the article flows better with a different structure, that's fine. Confident you all will work out the other matters, mindful of WP:FAOWN. SandyGeorgia (Talk) 19:49, 26 May 2024 (UTC)

I'll redo those changes now as you suggested, except for the order; I'm glad we were able to reach consensus there. You're welcome to tell me if you feel unhappy with any of my redone changes once I've made them.

Maybe I can better understand your reasoning for the order if you explain it to me. By "superior," do you mean that the current wording of the text is adapted to this specific order and would be less effective if changed? In that case, the words could theoretically be changed easily to maintain overall consistency in the articles while still allowing for flexible order. However, this doesn’t seem that important since you're not alone in your opinion, and even the guidelines of Wikipedia usually favor keeping the initial design of articles.

I'll have to accept that, even though I'm always a fan of questioning the status quo and changing it if there is a promising alternative. Sometimes, I know I can be a little too enthusiastic about this :D

The exchange here on Wikipedia is quite nice, I haven't planned to leave anytime soon. Oh, and don't worry, I already took a little peep at your activity too - it's great seeing other editors engaged in medical topics like you are ^^ –Tobias (talk) 16:55, 27 May 2024 (UTC)

@Tobiasi0: Oops sorry for the overlap in timing here. I believe I've just redone your image changes (except the histology image, per above), and your lead changes (except the clause at the end of the first sentence, which I think is useful context for the average reader – an unofficial survey of my non-specialist family members around me suggests that most people don't know what/where a prostate is). Ajpolino (talk) 16:56, 27 May 2024 (UTC)

Well then, I don't got an option to argue with that, fine by me 👀 –Tobias (talk) 17:00, 27 May 2024 (UTC)

Do you think we could embed 'screening' in 'prevention', or the other way around? Other ideas that come to mind are to incorporate 'special populations' into 'epidemiology' and to move the pure genetic and lifestyle information from 'epidemiology' to 'cause'. –Tobias (talk) 17:15, 27 May 2024 (UTC)

Nevermind, you already did. –Tobias (talk) 16:56, 27 May 2024 (UTC)

Perhaps instead of defending the current section order (which I do think is superior) I can reframe the distinction. The order you suggested is the generic order prescribed in MEDMOS; it's the status quo. Here, we have questioned that status quo and switched to a promising alternative that I believe improves the article's readability. It satisfies my (very small) inner iconoclast; I hope it does the same for you, when framed this way. Cheers. Ajpolino (talk) 17:01, 27 May 2024 (UTC)

It helps me understanding your thinking at least, thank you. –Tobias (talk) 17:19, 27 May 2024 (UTC)

I don't think there can be a standard order for medical conditions, since causes range from unknown to those understood in great detail, and treatments from an ensemble of options to none. The current order works Draken Bowser (talk) 20:32, 26 May 2024 (UTC)

 

Section order

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

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

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

Radiation side affects in Management#Localized disease

Planning to include Radiation-induced lumbar plexopathy in the existing sideaffect list. Reference is PMC3893894, sourced from ncbi.nlm.nih.gov/pmc/articles/PMC3893894. Any issues? TomStonehunter (talk) 16:16, 11 October 2024 (UTC)

Be my guest. The article uses a mildly confusing reference template style. Feel free to slap your addition in there, and I can fix any formatting issues if needed. Best, Ajpolino (talk) 19:03, 11 October 2024 (UTC)