Talk:Prostate cancer/Archive 2

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Screening useless?

An article in this week's Arch Intern Med[1] disputes the effects of DRE/PSA screening on mortality; it's a case-control study from a population of 71661, 501 of whom got prostate cancer and were matched with controls. JFW | T@lk 22:38, 9 January 2006 (UTC)

This is part of the difficult balance we faced with the screening discussion. We'd talked about having a whole article concerning the usefulness of screening and I would still be for it! InvictaHOG 22:52, 9 January 2006 (UTC)
I've nominated Screening (medicine) for the MCOTW. Please take a look. --Rewster 06:46, 10 January 2006 (UTC)


Celebrity sufferers

I have removed the list of celebrity sufferers from the page. I feel that if it belongs on Wikipedia, it should go on a separate page. Seriously, most men could be on this list and there's no easy way to verify (the list is not referenced!) InvictaHOG 02:10, 11 January 2006 (UTC)

Some prominent victims of prostate cancer (all deceased)

Link between masturbation and prostate cancer

I found an interesting article at the New Scientist website finding a ([[2]]) link between masturbation and prostate cancer. Way Back Machine ([[3]], [[4]]).

Basically in the article they were talking about carcinogens building up in the gland. At the end they pretty much summed it up by saying quote "The more you flush the ducts out, the less there is to hang around and damage the cells that line them"

Which I believe what they are saying is the more you clear the ducts of the carcinogens in your prostate the less likely you are to develop prostate cancer.

It's already in the article - InvictaHOG 02:44, 16 January 2006 (UTC)
I checked before posting this in the discussion. I just looked again under Prevention and couldn't find it. Out of slight curiosity, where is it exactly? Thanks va3atc
Epidemiology. There's no prospective data to suggest that it should be recommended for prevention. It's simply an observation. InvictaHOG 10:32, 19 January 2006 (UTC)

The edit that reintroduced the "masturbation - prevention of prostate cancer" linkage cited the discussion section of the cited manuscript. The discussion section does not support the specific link between masturbation and prostate cancer; in fact the authors state "The questionnaire focused on ejaculation irrespective of the context in which it occurred (intercourse with another, masturbation, nocturnal emissions, etc.)". Therefore, the specific attribution to masturbation of any finding in the paper is speculation and not supported .. cannot be supported .. by the data that they collected. Any re-introduction of this "fact" should be treated as vandalism. User:Ceyockey (talk to me) 21:40, 28 January 2006 (UTC)

If it was irrespective of any context then any context will do? That would include one would think masterbation. I think you use the term vandalism to lightly here, a carful wording with approprate citation saying essentally what you just said less the conclusion you drew that did not follow form yoru statments would be I think approprate for the article (not that I am going to add it). Dalf | Talk 22:25, 28 January 2006 (UTC)
I might add that at this point said link has entered the popular conciousness and if not true shoudl be debunked in the article, either way some mention is needed. Dalf | Talk 22:26, 28 January 2006 (UTC)
I disagree. The article covers the subject by presenting the relevant data with a link to a referenced, peer-reviewed article. There is no way at present either to prove or to disprove the "masturbation link" as presented in the disputed edit. I doubt that there will ever be a large scale prospective and/or randomized control trial of masturbation for prevention of prostate cancer, but we will certainly add it if the occasion presents itself! InvictaHOG 23:17, 28 January 2006 (UTC)

Excellent article, but I have a few thoughts

A few things I noted on the back of an envelope while reading this article:

1. As far as I am aware, there is no proof that carcinoma of the prostate (CaP) arises from prostatic intraepithelial neoplasia (PIN). The two are closely associated, and it has been estimated that approxiamtely 50% of men with high grade PIN will later have a diagnosis of CaP, but I have not read any proof that one leads to, or gives rise to, the other.

2. Your PSA values are not correct. Even using "older" reference ranges, above 4 ng/ml is abnormal. It is true that the risk of having CaP with a PSA of 4 - 10 does not change much across that range (approx. 25%), and significantly increases when above 10, I have never heard a PSA of, say, 9 being termed "borderline". More recently, in an attempt to improve the positive and negative predictive values of PSA, urologists are using age-specific reference ranges. Thus, 4.0 might be normal in an 80 year old, but abnormal in a 60 year old.

3. Lastly, you have incorporated the Gleason score in the staging of the disease. This is a bit of pedantry, but the Gleason score is *not* part of the staging. It is the grading of the disease. Two people can have identically staged diseases with different Gleason scores.

Other than these points, I think the article is spot on, and I don't think anyone would be grossly misled by the article as it stands (hence, I have not edited it). If anyone wants to incorporate my comments into the article, I would be pleased to find the appropriate references.

Jfbcubed 12:13, 29 January 2006 (UTC)

If it's wrong, fix it! Be bold! JFW | T@lk 12:37, 29 January 2006 (UTC)
Done Jfbcubed 13:12, 29 January 2006 (UTC)
Ta muchly :) GeeJo (t) (c) • 18:59, 29 January 2006 (UTC)

"cervix" vs. "uterine cervix" (resolved)

A recent edit altered the phrase "female cervix" to "female uterine cervix". Is this really needed, the addition of "uterine"? It seems that there wouldn't be any confusion or inaccuracy by leaving "uterine" out. User:Ceyockey (talk to me) 21:41, 29 January 2006 (UTC)

  • I added the word for clarity. I (as a urologist) have spent most of today trying to "tighten up" the nomenclature used in this otherwise excellent article. The linguists will be aware that "cervix" merely means "neck", and, in medical terminology, has many, sometimes 'non-female', uses. Otherwise, I agree with you. Remember, I was editing my own edit. Jfbcubed 21:48, 29 January 2006 (UTC)
    • It does not take a linguist to know that the term "cervix" is not specific to the female anatomical structure; this information is found in cervix at the very least. However, in the context used here and in common usage (as opposed to a medical textbook treatment), there can be no confusion. Also, it doesn't matter if you edited your own edit from my point of view. User:Ceyockey (talk to me) 21:54, 29 January 2006 (UTC)
    • A valid alternative would be to leave out the word "female". It has been so edited. Jfbcubed 21:52, 29 January 2006 (UTC)
      • Interestingly, the page you cite, cervix, refers only to the neck of the uterus and not the other uses of the word, but comments that it is also called the "cervix uteri". How is that (other than being in Latin) different than calling it the "uterine cervix"? Or is your objection to the word "female" (now removed)? Jfbcubed 22:00, 29 January 2006 (UTC)
      • Our edits came extremely close to colliding, thus my changing the indentation ... using "uterine cervix" and dropping the "female" tastes ok to me. It was the redundantness of having all three terms in the phrase. User:Ceyockey (talk to me) 00:05, 30 January 2006 (UTC)

External Link - American Cancer Society

A recent edit introduced then re-introduced after removal a link to the American Cancer Society in the External Links section. It seems that such a general link shouldn't be here, otherwise one should advocate addition of this link to every article in Wikipedia that has anything to do with cancer. User:Ceyockey (talk to me) 21:44, 29 January 2006 (UTC)

This was removed but it has been added back again. I'm wondering what the motivation is behind people adding this link back to the article over and over and over again? User:Ceyockey (talk to me) 00:07, 4 February 2006 (UTC)

External Link - Cancer Survivors Network

A recent edit introduced a link in the External Links section to the Cancer Survivors Network. This seems to be too general a link to include here and, like the American Cancer Society link mentioned above, could be added to every article in Wikipedia related to cancer. User:Ceyockey (talk to me) 21:47, 29 January 2006 (UTC)

Footnote numbering off by one

In the first section, there are two refs to ACS. They get numbered [1] and[2], although they point to the same numbered item. This is causing all the following refs to be off by one. I can diagnose the problem but I am not clear on how to fix it. David.Throop 03:01, 21 February 2006 (UTC)

Black men and prostate cancer

Hmm I want evidence to support the claim that cancer of the prostate is more deadly in black men than other men. I think the basis is that black men are less likely to seek help than others when it come to their cancer, but I doubt that it is more deadly because of the color of your skin. This claim should have a reference

  • Well, there's evidence both ways. This month's journal Cancer (106(6):1276-85) suggests that the racial differences might just be explained by socio-economic differences (although, even adjusting for all this, African Americans still had a slightly higher (but just significant) mortality than Caucasians...). Furthermore, a meta-analysis in Urology (2004 Aug;64(2):212-7) suggests black men with hormone-refractory prostate cancer have no increased mortality compared to white men.
  • On the other hand, there is evidence to support the assertion that, independent of reluctance to seek medical help, black men have a worse clinical course (see Freeman, et al. Am J Public Health. 2004 May;94(5):803-8). The SEER data analysis also found excess deaths in black men compared to white controls, but the dataset lacks potential confounders such social status (Ries, et al. SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute).
  • Whether ethnicity is, in itself, an independent preditor of disease outcome has been a matter of considerable debate for some time. There is a sizeable UK government study aimed, amongst other things, to try and establish this. For a reasonable review (albeit a bit out-of-date), see: Evans, S., Ben-Shlomo, Y. & Persad, R. (2003); "Prostate cancer in Black and White men: are there differences in risk or prognosis?". BJU International 92 (9), 878-879.

Jfbcubed 19:38, 3 April 2006 (UTC)


Preventable??

I have a serious problem with the following: "Many factors, including genetics and diet, have been implicated in the development of prostate cancer, but as of 2005, it is not a preventable disease."

Not preventable -- you mean despite the digital rectal exam, the PSA test, etc.

This is questionable and should be reviewed.

216.194.0.6 07:08, 10 April 2006 (UTC)

  • I think I understand what you are getting at, but, technically, the statement is true. There is a small amount of evidence regarding prevention, with respect to lycopenes, 5-alpha reductase inhibitors, etc., but nothing proven. I fear you may be misinterpreting "preventable" to mean "curable". The DRE and PSA will only detect disease that is present (and even that is debatable). It will not identify people who are going to get the disease, and therefore cannot ensure prevention.

Jfbcubed 19:37, 11 April 2006 (UTC)

According to the British Medical Journal in order to lower the pc occurrence by 50% is necessary to have at least 21 ejaculations per month. I've added a citation needed tag untile one is found.--BMF81 00:13, 24 August 2006 (UTC)

I have no idea what you are referring to here. I know of no (and a search has found none) study in the British Medical Journal dealing with prostate cancer and ejaculatory frequency. In fact, a large JAMA study found no association and the information on ejaculation is lucky to be in the article still. There's been one study (linked in the article) which was retrospective and simply found a correlation between a history of increased ejaculation and prostate cancer. Nowhere has there been a randomized or even simply prospective trial looking at ejaculation and prostate cancer and I would ask that you remove the citation needed tag unless you further explain what it is you object to. There has not been any proven method to prevent prostate cancer and the statement is thus true. InvictaHOG 09:34, 24 August 2006 (UTC)
Searching on google I've found that the research I was referring to, is actually already in the article :), as note 34. It is used in section "Epidemiology" with note 33 to substain: In recent years, studies have linked increased frequency of masturbation or ejaculation to decreased risk of prostate cancer. More precisely, Leitzmann's study (note 34) shows a risk decrease of 33% with at least 21 ejaculation per month. Should that sentence be moved to the article intro regarding prevention? Anyway I'll take out the fact tag until the end of discussion. (Redundancy note: Giles' study seems to present twice as note 23 and 33). --BMF81 10:32, 24 August 2006 (UTC)
I fixed the redundancy (it seems that half the people who edit the article have come here just to add that fact - I've removed several redundant instances in the past! I went ahead and got rid of the statement on prevention - it is a useless sentence fragment which can never be truly proven - how many cases do you have to prevent to say that prostate cancer is prevented? One? All? There's no need for it. If there were an easy way to explain the lack of prospective randomized data on prevention in the lead, it might be nice to add. But I couldn't think of one and it's out of the scope of the lead anyway, IMHO.InvictaHOG 10:44, 24 August 2006 (UTC)

A fine article

I'm a victim of prostate cancer, and I congratulate everyone involved in creating this excellent article, which is by far the best overview of the subject I've seen (and believe me, I've read everything I can). I just wanted to say to the younger men out there that my doctors have noticed a trend with younger men coming in -- some of them in their 20s -- with urinary dysfunction, and it turns out they have an aggressive cancer that has spread beyond the prostate. Please don't listen if your doctor tells you to wait until you're 50 to have a PSA test. Get it now.

  • My experience, being a urology resident involved in the largest prostate cancer screening trial ever attempted (ProTect), is that using PSA to screen for disease below the age of 50 is of little value. The current trial protocol invites men over 50 with PSAs >3.0 to have a biopsy. When the trial started, men over 45 with PSAs >2.5 were also invited. Few men were recruited in this group, but extremely few in this age group with this PSA had disease and so this arm of the trial was discontinued. I am not trying to discredit the sentiments expressed above, but it must be remembered that the positive predictive value of a test is exquisitely sensitive to the prevalence of disease in the measured population. Thus, the inherent value of a PSA test falls as the patient becomes younger (basically, a high PSA is more likey to represent benign inflammation the younger you are, rather than cancer).

Jfbcubed 19:48, 11 April 2006 (UTC)


Incidence rates that apply to the USA

When I read it, the article said:

It is the second most common type of cancer in men, and among men it is responsible for more deaths than any other cancer except lung cancer.

As prostate cancer rates vary profoundly throughout the world I have added a qualifier to the sentence. It now reads:

It is the second most common type of cancer in men in the United States, and is responsible for more male deaths than any other cancer except lung cancer.

Please see [5] Michael Glass 07:28, 12 April 2006 (UTC)

This is an article about prostate carcinoma, not prostate cancer

Okay, I'm being pedantic, but an encyclopedia probably should be pedantic. Prostate carcinoma is by far the most common form of prostate cancer, but prostate rhabdomyosarcoma is more common in children and younger men, up to something like 30 yrs old.

Either someone should do a global replace of "prostate carcinoma" for every "prostate cancer" including the title, or leave the title and replace most of the other references and add something about other forms of prostate cancer.

I'll do it myself, if others agree. But I didn't want to butcher up a featured article with my first contribution to it. Jpbrody 17:38, 17 April 2006 (UTC)

Well, if that's the case, shouldn't it be prostate adenocarcinoma then! Changing the title to "prostate carcinoma" is probably too pedantic and may be counterproductive to the overall goal of the article. Rather than a global replace, perhaps a mention of the distinction between adenocarcinoma and rhabdomyosarcoma would be helpful. Andrew73 17:50, 17 April 2006 (UTC)
I also think it is pedantry, but I guess I agree with the accuracy. There are also other types of prostate tumours (including malignant solitary fibrous tumour of the prostate we've described, see [6]) It should read "adenocarcinoma" - but I would leave the title as "Prostate Cancer" - we still want people to find the page! Jfbcubed 18:08, 17 April 2006 (UTC)

Wikipedia:Version 0.5 Nominations

This article has been selected for inclusion into Version 0.5 due to its importance and quality; however, is it possible to convert the bare links on the lead section to proper references? Titoxd(?!? - help us) 07:41, 31 May 2006 (UTC)

Prevention and Epidemiology

Hi, I noticed your edits on prostate cancer. I'm not sure what the driving force for consolidation of the Prevention and Epidemiology sections was. They are obviously quite different in scope, though some overlap is to be expected (and could be excised!). It also deviates from the template for medical articles and makes the epidemiology section quite long. I am inclined to revert the changes but would love to hear your thoughts on the matter! You can either reply on my talk page or that of prostate cancer! InvictaHOG 20:38, 17 August 2006 (UTC) Copied here by Nunquam Dormio 12:12, 18 August 2006 (UTC)

Hi InvictaHOG, The 'driving force' was someone adding stuff about lycopene into Prevention that was already present in Epidemiology. There is also duplication over other items e.g. ejaculation frequency. In a spontaneous decision, I thought it best to get these overlapping sections together, so duplication and differences are made more obvious and can then be added. I wasn't aware of any template and don't have strong feelings about restoring two sections, just so long as they have clear and distinct purposes and don't end up largely overlapping. Nunquam Dormio 12:12, 18 August 2006 (UTC)

rate of deaths

I don't see anywhere in the article where it says this and I think it's of importance since that's what I was looking for when I looked for this article. 84.109.52.88 18:50, 2 September 2006 (UTC)

The prognosis section breaks it down by country, diagnosis, etc. If you need something more specific, just let us know and we'll add it if it is known. InvictaHOG 22:19, 2 September 2006 (UTC)
Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.