Talk:Prostate cancer

From Wikipedia, the free encyclopedia

	Prostate cancer is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. If you can update or improve it, please do.
	This article appeared on Wikipedia's Main Page as Today's featured article on January 29, 2006.
Article Milestones Date Process Result November 29, 2005 Peer review Reviewed December 16, 2005 Featured article candidate Promoted Current Status: Featured article

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
FA	rated as FA-Class on the assessment scale
High	rated as high-importance on the assessment scale

This article was previously a Medicine Collaboration of the Week.

This article has been selected for Version 0.5 and the next release version of Wikipedia. This Natsci article has been rated FA-Class on the assessment scale.

This article was selected on the Medicine portal as one of Wikipedia's best articles related to Medicine.

Archive: 1.

Contents 1 etiology, causation and association 2 MCOTW 3 My thoughts for this page 4 Lycopene 5 Splits 6 Screening 7 Gene names 8 Surgery section 9 Anything else? 9.1 TURP 10 Screening useless? 11 Celebrity sufferers 12 Some prominent victims of prostate cancer (all deceased) 13 Link between masturbation and prostate cancer 14 Excellent article, but I have a few thoughts 15 "cervix" vs. "uterine cervix" (resolved) 16 External Link - American Cancer Society 17 External Link - Cancer Survivors Network 18 Footnote numbering off by one 19 Black men and prostate cancer 20 Preventable?? 21 A fine article 22 Incidence rates that apply to the USA 23 This is an article about prostate carcinoma, not prostate cancer 24 Wikipedia:Version 0.5 Nominations 25 Prevention and Epidemiology 26 rate of deaths 27 Gamma-rays vs. X-rays 28 "Stiffness"

[edit] etiology, causation and association

Dr Wolff, you are wrong. We know the etiology of few cancers, and should not confuse a model of pathogenesis with understanding causation in prostate cancer. The etiology of cancer of cervix seems to be HPV, under the influence of several epidemiologically identifiable co-factors and promotors. If you know the causal etiology of prostate cancer, please enlighten us. If you understand this, you may revert your edit, and retract your comment. Bcameron54 20:29, 29 January 2006 (UTC)

[edit] MCOTW

I'd thought it would be nice to merge all previous debate into the archive and start with a tabula rasa.

This article, describing one of the most common forms of cancer, has undergone relatively little editing since landing on Wikipedia[1] from an NIH page (here). It contains duplicate material which can easily be merged into prostate and prostate specific antigen. The English is rather lay-oriented and can probably be streamlined.

Ideally, we should get a surgeon or urologist on-board to describe the indication, procedure and outcomes of radical prostatectomy and other methods. We need to identify pivotal trials that showed the benefit of goserelin and bicalutamide, the preventative and therapeutic use of finasteride, and indications for orchidectomy. What radiotherapy modalities are used (we can ask User:Brim or User:Andrew73) and has brachytherapy been tried?

For an issue like screening you really need a clinician who does screening, that is dealing with asymptomatic men. In post parts of the world this is a primary care physicians role.

I'm interested to see how this article will fare! JFW | T@lk 01:56, 22 November 2005 (UTC)

Brachytherapy is definitely being used, e.g. Theraseed. Prostate cancer is not my area of expertise, but I'll see if I can add some cents here and there! Andrew73 02:45, 22 November 2005 (UTC)

I actually have an image of brachytherapy seeds (along with a few more) that I'm going to put up whenever the servers are upgraded and we can upload again! InvictaHOG 02:54, 22 November 2005 (UTC)

[edit] My thoughts for this page

I am inclined to scrap the current layout in favor of the clinical medicine template. I've started by rewriting the prostate section and moving the symptoms up. I think that we should make the oncogenesis portion into pathophysiology and incorporate all of the risk factor stuff into one epidemiology section. I have images for Gleason, brachytherapy, and microscopic pathology that I'm working on. I don't have a good gross path, but I'm working on it. There's a lot of fluff that can be cut and condensed. I'll be reading about staging and therapy over the holidays but might not be able to add much to the article during that time. I think that off-loading the staging would be awesome. We might even end up off-loading the therapy section, but it doesn't look like we'll need it right now. I think that screening should remain a separate section within diagnosis. We could probably benefit from a separate Gleason article, probably best linked under diagnosis or prognosis. InvictaHOG 04:08, 23 November 2005 (UTC)

I have replaced the epidemiology, prostate, and symptoms sections with referenced prose. I think that the rest of the article deserves the same treatment. I'd probably hold off on copyediting the rest until that change has been made. It might take another week, but I think that this article has quite a ways to go to be great. I don't want anyone to waste time correcting wording, etc. that will just be replaced anyway! InvictaHOG 16:22, 25 November 2005 (UTC)

I've referenced everything but the diagnosis and treatment sections. Hopefully will finish one or both over this weekend. I replaced the lead article because it looked poorly scanned (could see lettering in background!). Hopefully the new lead is more acceptable. I'm looking into adding a history section, as well. I have a few web leads but need to track down a few textbooks to verify. I've started a Gleason article with an image and a transrectal ultrasound. We still need articles for the surgeries and the SERMs that I added to prevention. I expect that the treatment and diagnosis section will condense greatly and the length of the article will be better, as well! Soon we'll be able to delete the disclaimer at the bottom and claim the page as our own instead of an outside government agency! InvictaHOG 04:32, 1 December 2005 (UTC)

I can hopefully help reference some of that as well. Great job with the Gleason's article—I can't believe you just whipped that up! By the way, I nominated it on for WP:DYK. — Knowledge Seeker দ 05:17, 1 December 2005 (UTC)

Thanks for the nomination, Knowledge Seeker! I've added a history section - I didn't realize that there were two Nobel prizes so closely associated with prostate cancer! Hopefully the treatment and diagnoses sections will be done over the weekend and anything else that pops up on peer review can be addressed. InvictaHOG 21:36, 2 December 2005 (UTC)

I've added some images and reworked the screening and diagnosis sections. Just the treatment left right now. InvictaHOG 21:17, 4 December 2005 (UTC)

Just needing references for radiation and hormone therapy. Got rid of a lot of red links today, have a few more to go. Working on an image for the different hormone therapies. InvictaHOG 03:21, 6 December 2005 (UTC)

Finished the image tonight. Hopefully finish the hormonal therapy section tomorrow night. I'll write the radiation proctitis article, too. Interesting thing that I hadn't run into much before InvictaHOG 05:15, 8 December 2005 (UTC)

[edit] Lycopene

Where was that study that tomatoes are good? JFW | T@lk 08:45, 23 November 2005 (UTC)

Free full text review of evidence at PMID 16130015 InvictaHOG 14:09, 23 November 2005 (UTC)

[edit] Splits

This article is quite long, which is not necessarily a bad thing. I split the Prostate cancer#stages off to a separate article, Prostate cancer staging. Are there any other sections that would benefit from being split off? That is, are there any we'd like to expand but we're trying to keep from over-burdening this article? — Knowledge Seeker দ 19:48, 29 November 2005 (UTC)

I still think that it needs a lot of work. I plan on reworking and referencing the treatment section. I think it may end up needing to be off-loaded. We'll have to see! InvictaHOG 19:57, 29 November 2005 (UTC)

A thought -- most of the content in "Pathophysiology" has nothing to do with prostate cancer per se, and could be replaced with a single sentence with relevant links. --Arcadian 23:13, 29 November 2005 (UTC)

[edit] Screening

I have a concern about the 'Screening' section, but I know it's somewhat controversial topic, so I wanted to take it here instead of just editing it myself. The second paragraph seems to have a POV on discouraging people from having the PSA test. At least we should find some recommendations from different organizations. Here's some useful links about recommendations, and here's some research on the correlation of PSA with cancer: PMID 12110095, PMID 10925094, PMID 10882875, PMID 12670561, PMID 11584785. --Arcadian 22:34, 2 December 2005 (UTC)

Screening was the one thing that I knew would be sticky beforehand. I've been trying to read as much as possible and am hoping to make a valiant effort this weekend to get a referenced section. It's difficult because several societies recommend large-scale PSA screening while the Evidence based medicine group does not. Everything should definitely be presented in a NPOV way! InvictaHOG 22:50, 2 December 2005 (UTC)

PSA velocity, gentlemen. JFW | T@lk 02:48, 4 December 2005 (UTC)

Even PSA velocity isn't that grand. I'm going to spend all day on it tomorrow! InvictaHOG 03:19, 4 December 2005 (UTC)

I think that prostate cancer screening could probably do with an article all its own. The whole issue of informed consent, etc. is just way too much to include in this article. It's hard to imagine having a complete discussion about prostate cancer without at least mentioning it, however. InvictaHOG 21:17, 4 December 2005 (UTC)

Yeah, it does need to be split off. I can work on that tonight. Nice job on taking care of the red links. People are going to wonder why so many prostate-cancer-related items are appearing on DYK ;) (Gleason score, prostate cancer staging, flutamide, and so on). — Knowledge Seeker দ 23:53, 6 December 2005 (UTC)

I started the split; it's just a stub so far but I'll expand it tomorrow and perhaps trim a bit here then. Keep up the good work, InvictaHOG. — Knowledge Seeker দ 07:33, 7 December 2005 (UTC)

Awesome! I rewrote the radiation therapy section. It really sucks when an article has been poached from a well-written site. It's much easier to write one from scratch than to have this nice prose just sitting there taunting you. I strongly feel that a featured article should not contain passages lifted wholesale from other sites, but it's hard to cut out good explanations of concepts like radiation therapy. Right now the only part that needs to be replaced is hormone therapy - I'm going to work on the section and an image tonight. I think that a section on palliative/salvage therapy might be nice, too. A few more red links, and then I think it will be ready! InvictaHOG 11:21, 7 December 2005 (UTC)

[edit] Gene names

Do the names of genes, such as BRCA1 and BRCA2, need to be italicized? The Gene page nomenclature section refers to the HUGO database, where the names are not italicized, and they are also not italicized on Wikipedia's List of notable genes. Rewster 17:19, 9 December 2005 (UTC)

You got me there, I haven't a clue if there is a convention or whether we're following it! InvictaHOG 20:13, 9 December 2005 (UTC)

Short answer: yes. The Chicago Manual of Style (15th ed.) recommends: "8.140 Genes. Names of genes, or gene symbols, including any arabic numerals that form a part of such names, are usually italicized...Gene names contain no Greek characters or roman numerals. Human gene symbols are set in full capitals, as are the genes for other primates...Protein names...are set in roman." So the VHL gene produces VHL protein. This matches both my New England Journal of Medicine and Harrison's, so unless anyone has any objections, I'll modify the entries accordingly. I'll try to incorporate this into the Manual of Style as well. — Knowledge Seeker দ 07:12, 14 December 2005 (UTC)

[edit] Surgery section

Can we find references for the statistics (70% cure and 40% incontinence)? And any info on cure stats with radical perineal prostatectomy?

Also, I noticed that we now have articles on prostatectomy, radical prostatectomy, radical retropubic prostatectomy, and radical perineal prostatectomy. Some are better than others. Should we do some combining?

Rewster 03:34, 10 December 2005 (UTC)

I redirected radical prostatectomy to prostatectomy and cleaned-up prostatectomy with links to perineal and retropubic. The data on outcomes in perineal is lacking, but it's thought to be at least as good as retropubic. As for the results of radical prostatectomy, they're in the paper cited under as reference 31

Gerber GS, Thisted RA, Scardino PT, Frohmuller HG, Schroeder FH, Paulson DF, Middleton AW Jr, Rukstalis DB, Smith JA Jr, Schellhammer PF, Ohori M, Chodak GW. Results of radical prostatectomy in men with clinically localized prostate cancer. JAMA. 1996 Aug 28;276(8):615-9. PMID 8773633

InvictaHOG 03:51, 10 December 2005 (UTC)

[edit] Anything else?

I finished reworking the hormone section today. There are a few red links which I plan to address tomorrow! I struck out the box - anything else we should be addressing? InvictaHOG 03:53, 10 December 2005 (UTC)

No more red links! InvictaHOG 04:26, 11 December 2005 (UTC)

How about putting it up for featured article candidate right now and see what comments come from that? --WS 04:29, 11 December 2005 (UTC)

Done! InvictaHOG 07:10, 11 December 2005 (UTC)

Can we strengthen the prognosis section? Currently it only contains information that can be found elsewhere in the article. Suggestions? --Rewster 06:20, 12 December 2005 (UTC)

Someone commented on the Featured article candidates page that "it would be nice to know the prognosis for men with prostate cancer in places other than the United States". I found a link that indicated that the survival rates are not as good in Europe due to lack of standardised early screening. This is beyond my area of expertise, so perhaps one of you might be able to work with it. Edwardian 06:58, 13 December 2005 (UTC)

Careful with any assumption that screening affects survival rates for prostate cancer. This a controversial and heavily politicised area. It has not been clearly proven. There are confounding factors such as lead time bias, and comorbid conditions in this mostly elderly population. I cannot find a ref to Wilson's screening criteria on Wiki, but there should be since this is an important topic which puts cancer screening in general in perspective. Need an epidemiologist.Jellytussle 01:02, 14 December 2005 (UTC)

You are absolutely correct (not that I had to tell you that!). I purposely avoided addressing the topic because it is simply too messy and honestly didn't think it belonged here. It's the primary reason why I was hesitant to start rewriting prostate cancer in the first place! I thought about writing a separate article, but figured it would be of limited usefulness compared to the other topics which require attention. I've not personally heard of Wilson's criteria before...maybe you can write the article and teach us all something! InvictaHOG 01:14, 14 December 2005 (UTC)

Is this what you're referring to? --Arcadian 01:57, 14 December 2005 (UTC)

See my comments in the discussion on the screening (medical) page. There should be enough material there for someone to work with.Jellytussle 04:54, 14 December 2005 (UTC)

[edit] TURP

Please remove (or edit) the reference to TURP in the surgical treatment of cancer. TURP is for benign disease . Only role in prostate cancer is to palliate obstruction. It is not used with curative intent , and this should be made clear. The current version may lead a lay person to think TURP is used for cancer treatment. —The preceding unsigned comment was added by Tony Makhlouf (talk • contribs).

This has been clarified in the article. Andrew73 17:05, 18 December 2005 (UTC)

[edit] Screening useless?

An article in this week's Arch Intern Med[2] 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)

[edit] 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)

[edit] Some prominent victims of prostate cancer (all deceased)

• Lew Anderson, American television actor
• Roone Arledge, pioneering American television producer
• Michael Bentine, British comic actor
• Bill Bixby, U.S. actor
• Stokely Carmichael, African-American (later based in Guinea, Africa) activist and black separatist
• Eldridge Cleaver, African-American activist
• Silvio O. Conte, Massachusetts politician
• Hume Cronyn, Canadian-born U.S. actor
• Richard Egan, actor
• Dean Gallo, U.S. politician
• Charles Haughey, 1980s Irish Taoiseach
• Chic Hecht, U.S. politician
• Charles Johnson, African-American sportsman in segregated times
• John B. Keane, Irish writer, novelist
• Timothy Leary, U.S. social activist
• Spark Matsunaga, U.S. politician
• François Mitterrand, French president
• Jerry Orbach, U.S. actor
• Joseph Papp, NYC stage director/producer
• Linus Pauling, scientist
• Johnny Ramone, musician from The Ramones (born John Cummings)
• Thurl Ravenscroft, U.S. voice actor
• Bobby Riggs, U.S. tennis player
• Michael Ritchie, film director
• Steve Ross (Time-Warner CEO), conglomerateur
• Telly Savalas, U.S. actor
• Dick Sargent, U.S. actor
• Sir Harry Secombe, British actor
• Francis Alexander Shields, father of Brooke Shields
• Jesse Unruh, California politician
• Richard VanderVeen, American politician
• Sam Wanamaker, expatriate American actor/director
• Walter Winchell, newspaper columnist and radio personality, devoted to gossip
• Ludwig Wittgenstein, German philosopher
• Earl Woods, former Green Beret & father of Tiger Woods
• Frank Zappa, U.S. musician

[edit] Link between masturbation and prostate cancer

I found an interesting article at the New Scientist website finding a ([[3]]) link between masturbation and prostate cancer. Way Back Machine ([[4]], [[5]]).

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)

[edit] 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)

[edit] "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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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 [6] Michael Glass 07:28, 12 April 2006 (UTC)

[edit] 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 [7]) 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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] Gamma-rays vs. X-rays

I'd just like to point out that linear accelerators produce radiation by accelerating electrons and focussing them at a high-Z target. The resulting Bremmstrahhlung photons are technically x-rays. Gamma-rays are produced by radioactive decay of an unstable isotope, the most famous in the context of radiotherapy being Cobalt-60. —The preceding unsigned comment was added by 137.82.96.26 (talk) 05:17, 4 January 2007 (UTC).

It sounds like you know far more about this than I do. Feel free to edit the article! InvictaHOG 19:55, 5 January 2007 (UTC)

[edit] "Stiffness"

Someone replaced "erection" with "stiffness" in the Symptoms section. I have changed the word back to "erection," since this is the legitimate, neutral term for erection of the penis. People, this is the prostate cancer page, we should be mature enough to have the word "erection" on it. "Stiffness" seems like something Borat would say, or akin to the slang "stiffie," and is not a good euphemism for "erection." It is what it is. The animal researchers call erections "flips," but I don't think laypeople would understand that word. I hope nobody reverts the word back. Whatever, there are thousands of words in the article, but this one matters some.--Dr.michael.benjamin 04:09, 2 March 2007 (UTC)