Talk:Prostate cancer/GA1

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Reviewer: Femke (talk · contribs) 09:24, 3 March 2024 (UTC)

Will be taking this on this week. I did a first read-through of the article, and in most places the prose is excellent. Are you planning to take the article to FAC? Happy to nit-pick a bit more if that's the plan. Initial thoughts:

• "Most cases are detected after screening tests – typically blood tests for levels of prostate-specific antigen (PSA) – indicate unusual growth of prostate tissue" --> This is awkward because the first sentence fragment (Most cases.. tests") feels like a complete sentence. The verb indicate then comes as a surprise. My first intuition was to replace "after" with "when", but perhaps this loses precision as the actual detection happens with a biopsy(?). ChatGPT suggested: "Abnormal growth of prostate tissue is usually detected through screening tests, typically blood tests that check for prostate-specific antigen (PSA) levels"
  • I tried a few different wordings, but actually I quite like the ChatGPT one. Added another sentence after to clarify. Let me know if I've made it clunky.
• In particular, many measure "free PSA" – the around 10–30% of PSA unbound to other blood proteins --> the combination "the" and "around" makes for awkward prose. A bit more wordy: free PSA" – the fraction of PSA unbound to other blood proteins, which is usually around 10% to 30%.
  • Done.
• As those severely ill with metastatic prostate cancer near the end of their lives, most experience confusion and may hallucinate or have trouble recognizing loved ones --> the word near here can be read both as a verb and a adverb. Approach may be clearer.
  • Done.
• I would add a linking word (such as However) before "Analyses of internet searches..". It took me a second read to understand the second sentence meant to contrast the first.
  • Done.
• No source for the blue ribbon.
  • It has been weirdly difficult to source. Google prostate cancer ribbon and you'll see they're light blue. But I've struggled to find a good source for it. The Prostate Cancer Foundation calls its donor group the "blue ribbon society" but they don't just out and say the thing I need them to say. Here's a WebMD article that states it clearly? I know WebMD makes the medicine folks cringe. Alternatively I can just cut it out. Perhaps if no one talks about it, it's just not that important. What do you think?
    • I think either option is fine, leaning towards your solution of cutting it out. In Google News search "pink ribbon breast cancer / blue ribbon prostate cancer", I get our classical HQRS for breast cancer, but not for prostate cancer, implying it's not that important. I don't mind WebMD for completely unambigious things like this. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
      • Fair, removed for now (possibly for good). Ajpolino (talk) 20:01, 13 March 2024 (UTC)

—Femke 🐦 (talk) 09:24, 3 March 2024 (UTC)

Hi Femke, thank you for taking up the review. I'm traveling this weekend but should be back in business in a day or two. I am indeed hoping to bring this article through FAC, so any nitpicking you're willing to do is much appreciated. Thanks again! Ajpolino (talk) 12:57, 3 March 2024 (UTC)

Brilliant. I'll put optional where it's not needed for GA, but may be good for FA. —Femke 🐦 (talk) 14:30, 3 March 2024 (UTC)

• Explain vas deferens?
  • Added parenthetical "(the duct that delivers sperm from the testes)". Is that alright? If I add where it delivers the sperm to, I'll have more jargon (in case you're curious, here's a nice diagram. It joins with the end of the seminal vesicles to form the ejaculatory duct, which dumps into the urethra in preparation for an orgasm. Takes a surprising number of moving parts to get the job done).
    • Perfect. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• The article doesnt't talk too much about side effects of treatments other than surgery, might be good to expand on this (optional). I imagine that low testosterone levels may have quite significant side effects?
  • They do. Will add something.
• or a rapid rate of PSA level increases --> or quickly rising PSA levels.
  • Done.
• and eventually can kill the affected person --> word order, can eventually may be better. Or simply can.
  • Went with your first suggestion.
• "Some PINs continue to grow, forming layers of tissue that stop expressing genes common to their original tissue location – p63, cytokeratin 5, and cytokeratin 14 – and begin expressing genes common to cells that makeup the innermost lining of the pancreatic duct." --> make up should be two words. The last bit might be better expressed as "and instead begin expressing genes typical of cells in the innermost lining of the pancreatic duct".
  • Done.

Source check

I check sources when I'm surprised by the facts or when I don't understand the text fully, and supplement this with a few random searches if the text is clear.

• As a tumor grows beyond the prostate .. Works out, but source indicates some people may already have trouble urinating in the early stages. Might be good to mention for comprehensiveness (optional)
  • It's gently controversial, but I've worded it in a way that I think captures the mainstream consensus. I like to use the American Cancer Society pages as sources early in sections because I think they're nicely understandable to layfolk, and typically up-to-date. Here I think they overstepped a bit with their wording, but perhaps I should either dutifully follow them or find an authoritative source more in line with the current wording.
• Advanced prostate tumors often metastasize to nearby bones of the pelvis and back --> the first bit of the sentence does not seem covered by this sentence.
  • Note to self to tweak wording to match Rebello Fig. 3C.
  • Added a ref and tweaked the wording to match. It now says particularly in the pelvis, hips, spine, ribs, head, and neck. My question for you: is the list now long enough that it's uninteresting? I could just leave it at "lymph nodes and bones". I'm trying to get across something curious about prostate cancer, which is that it metastasizes to bones a lot, and prefers some bones over others (basically it prefers bones of your torso and head rather than the limbs). Contrast with lung cancer, which metastasizes to many organs. Happy to hear your thoughts on what's clear and interesting.
• This is done through blood tests.. I don't have access to the Nature paper, but the CDC seems to put the digital rectal exam and the PSA test on equal footing for screening. THe other source is higher-quality, so good to defer to that one.
  • The Rebello source is available through The Wikipedia Library (I'll throw in a plug for User:Smartse's Redirector extension rules, mentioned here, which I find to be a great convenience). It says frankly "Screening methods primarily involve measurements of the blood serum biomarker PSA". I understand what you mean, but I don't think they're meant to be presented on equal footing. The CDC site only gives DREs two sentences, one to explain what they are, and the other to explain that they aren't recommended because they don't seem to help.

    Apologies, I did not properly read the text under the heading. You're absolutely right. —Femke 🐦 (talk) 19:29, 8 March 2024 (UTC)

    And thanks for the link so Smartse's extension thingie. The one I tried out a few years back didn't work for me.

• Those with PSA levels below average are very unlikely to develop dangerous prostate cancer over the next 8 to 10 years Correct
• The average man's blood has around 1 nanogram (ng) of PSA per milliliter (mL) of blood tested The text says median, and given the numbers in the paper, I think this distribution is heavy-tailed. That is, the median is likely lower than the average/mean. If you want to avoid the word median, typical may be a good translation.
  • Sure, changed to "typical".
• Those at higher risk may receive treatment check
• In their last few days.. check
• Particularly large PINs can eventually grow into tumors. I can't find it in the source; however, the source has a lot of technobabble I do not understand.
  • Softened the wording to Some PINs can eventually grow into tumors and added a source that notes "high-grade PIN is considered a pre-cancer of the prostate, because it can turn into prostate cancer over time" (I decided not to make the low-grade vs. high-grade distinction in this article because I don't think it's important enough to merit inclusion. The section is already pretty jargon rich.)
• and mutations that hyperactivate FOXA1 (up to 5% of tumors). check
• Analyses of internet searches.. --> the source says it doesn't increase much, but a small increase was observed.
  • I've made the smallest change to "neither event changes the level... much,". Happy to more boldly reimagine (or even remove) this if you think it's best.
    • This is exactly what I had in mind! —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• Prostate cancer is a major topic of ongoing research – the U.S. National Cancer Institute (NCI, the world's largest funder of cancer research) spent $209 million on prostate cancer research in 2020 – the sixth highest among cancer types. Check, but 2021 data is out now; it's now the 4th-highest :). The weird doubling in brain&CNS research funding for 2020 seems to have been a blib.

—Femke 🐦 (talk) 17:51, 5 March 2024 (UTC)

• • Excellent! Updated.

The lead is missing citations. Each sentence in a medical article, including the lead, should have a citation. Readers should not have to search for relevant text or relevant citations within the document. Please see discussions about citations at WT:MED, WP:MEDMOS, WP:MEDRS, and WP:MEDCITE. -- Whywhenwhohow (talk) 19:12, 9 March 2024 (UTC)

Lead citations are optional, also for medical articles. Of the links you gave, only the essay WP:MEDCITE says it's adviseable to add citations to the lead in medical articles (as medical article's leads are more likely to be translated). A GAN is not the location to argue this. You probably want to create consensus in a guideline for this instead. —Femke 🐦 (talk) 09:20, 10 March 2024 (UTC)

I started a discussion at WT:MED#Citations --Whywhenwhohow (talk) 17:20, 10 March 2024 (UTC)

Second reading

Lead

• Those whose cancer spreads ... --> would the first "that" better replaced with which?
  • Done.
• Eventually cancer cells .. The text makes it seem this always happens. Is that correct? If so, a statement that (only) castration-resistant prostate cancer is incurable in the body feels a bit odd, as the previous stage already leads to CRPC.
  • Added "can".
• Last sentence lead is bit too wordy. I don't find Nobel Prizes lead-worthy myself, but opinions will vary. If you include it, it can be condensed. Something like: "For their breakthroughs in hormone therapies for prostate cancer, Charles B. Huggins received the 1966 Nobel Prize, and Andrzej W. Schally the 1977 Nobel Prize." It's clear which Nobel Prize is meant.
  • I've changed the wording to a version of your suggestion.

Diagnosis

• help assess --> assess?
  • Done.
• I didn't understand the paraphraph on the Gleason grading system. In particularly, what is meant by "common pattern" or second-most common pattern.
  • Hmmm... thinking about how to reword. Basically imagine you're looking at a prostate biopsy. In most of the biopsy you see tissue that looks somewhat cancerous, in one or two places you see tissue that looks very cancerous. You assign two scores: one for the phenomenon you saw the most of (the somewhat cancerous), and a second for the phenomenon you saw the second most of (the very cancerous). Even though you add them together to get a final Gleason score, the order sometimes matters -- a 4+3 (more cancerous tissue is most common) is considered differently than a 3+4 (less cancerous tissue is most common). The source uses the word "pattern" but I agree it's opaque. Any suggestions?
  • Would it be any clearer to change it from the pathologist assigns a number from 1 (most similar to healthy prostate tissue) to 5 (least similar) for the most common pattern observed under the microscope, then does the same for the second-most common pattern. The sum of these two numbers is the Gleason score. to the pathologist assigns scores of 1 (most similar to healthy prostate tissue) to 5 (least similar) to different regions of the biopsied tissue. The sum of the most common two scores is the "Gleason score", ranging from 2 to 10.? Some tweaking would still be required for the grade group explanation below.
    • I sort of guessed right what was meant. I think what makes it different for me to understand is the scale and nature of these "patterns" or phenomena.. Is it cells that have a different pattern? Or bigger regions? The word region answers the scale question a bit: it is bigger than cells, right? This may tie into the micrograph question. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
      • Yep, bigger regions. It's not a single cell that would look cancerous per se, rather clumps of cells that would look funny and be arranged in an unusual way. Ajpolino (talk) 20:41, 13 March 2024 (UTC)
      • Well I've implemented a version of the above. Hopefully it's at least a step in the right direction. Take a look and let me know what you think. Ajpolino (talk) 21:22, 15 March 2024 (UTC)
• The micrograph image should be connected better to the text. Micrograph is jargon: can we say microscopic image or is that something else? I don't understand what is shown on the image. Is it a biopsy? What is a perineural invasion? How can I see that in the image?
  • Note to self to look for a better image (or to tie this one into the text better).
  • I've spent a few hours poking around at images, and I'm not sure I can clearly illustrate the histology with just one image. I've tried out a replacement image showing some of the imaging done to detect if the cancer has spread. Let me know if you think that's helpful. Ajpolino (talk) 20:53, 19 March 2024 (UTC)

Management - Prognosis

• The first line of treatment --> awkward going from singular to plural. You could say "involves" rather than is?
  • Done.
• The if needed in the first sentence feels a bit odd. Normally, I think we use that wording when something become more intense, right? "as needed" may be more appropriate here?
  • Done.
• An alternative is the cell therapy .. -> can we omit "into the same person"
  • Sure, done.

Cause - Epidemiology

• "Eventually, tumor cells develop the ability" --> always? (similar to lead)
  • Added "can" as above.
• Metastases cause most of the discomfort --> needed in cause? Feels more like management (which covers this already)
  • The way I see it is that this section explains both "what causes a tumor to form in your prostate", and "what causes a prostate tumor to kill you". My preference would be to leave it in, but if others at an FAC (or this talk page) prefer it cut, that's ok; this is not a hill I need to die on.
    • I'm happy to go with your preference here. —Femke 🐦 (talk) 17:57, 13 March 2024 (UTC)
• I was a bit surprised that there wasn't information about risk factors in the cause section. I see you covered this in epidemiology. I trust your judgement on this, but took me a while to find the information. Both cause and pathophysiology focus a lot on the mutations. Can we say more about other processes? For instance, in lung cancer, you talk about how tumors cause blood vessel growth to be stimulated.
  • Fair. There's not always a clear distinction between epidemiological association and cause-related risk factor. Most of the sources I used here classified the information as "Epidemiology" (which you can see by glancing through the titles of the referenced articles and cited sections) so I mirrored that here. I see it's flipped at lung cancer. Can't recall if I was following the sources there, respecting a division that predated my involvement, or if it's arbitrary.
  • As to the second part of your question, let me look into it. There's probably source material to support a few broader framing sentences like at the lung cancer article. Might help a reader make slightly more sense of the gene mutation alphabet soup.
    • Added a couple of sentences. Ajpolino (talk) 00:41, 20 March 2024 (UTC)
• though incidence is increasing in these regions at among the fastest rates in the world --> bit awkward, maybe more concise like "though incidence is increasing fast in these regions"?
  • Changed to a variation of your suggestion.
• Together known gene --> Together, known gene
  • Done.
• cruciferous --> gloss
  • Any suggestions? "Leafy greens" isn't a perfect overlap. Apparently "brassicas" only refers to a subset. Adding (a family of vegetables) doesn't seem to lend much meaning.
    • Given one or two examples might be easiest?
      • Done.
• genistein --> explain
  • Done (found in soy).

—Femke 🐦 (talk) 20:35, 7 March 2024 (UTC)

History - Research

• The history section has a surprising number of jargon: histologically, urethra, transcretal.
  • Changed histologically, but I'm not sure I've captured the distinction between the two cases. In 1817 Langstaff pulled a hard lump of tissue out of a dead man's prostate and wrote "ah, a tumor, curious". In 1853 Adams pulled a hard lump of tissue out of a dead man's prostate. He had it sliced, stained, and examined by an expert, who confirmed that the lump was indeed cancerous. Some sources credit only Adams. Others mention both. Explaining here with the hope that you might have a suggestion for clear wording.
    • Is it possible you forgot to click publish here? —Femke 🐦 (talk) 19:51, 14 March 2024 (UTC)
      • Er yes *facepalm*. Lord knows where that browser tab went. Well I've tweaked the wording again. Even published it this time. Hopefully the distinction between Langstaff's and Adams' tumors isn't too opaque.
  • Transrectal ultrasound (was a typo, sorry) and urethra are wikilinked at earlier mention. Do you think another WL is merited? Replacing the words is challenging.
    • Transrectal is certainly more understandable than transcretal, so wikilink is fine. I am a fan of the new rule of wikilinking jargon once per section. I find urethra still difficult to understand. I see it's explained once in an image, but that's all the way up in signs and symptoms. Perhaps explaining it the second time it's used in the text (first time is under image) might help? And then wikilink in history? —Femke 🐦 (talk) 19:51, 14 March 2024 (UTC)
      • I gave it a parenthetical explanation at first use, and wikilinked it here. Let me know if there's other jargon you'd like evened out. Ajpolino (talk) 21:22, 15 March 2024 (UTC)
• I'm always surprised to see all discovering made in the English-speaking world. Couldn't find a contradiction on dewiki/frwiki, so I'm going to assume this isn't just English-speaking sources unaware of the rest of the world.
  • True, it is suspicious.
• Continuing on the above, I was surprised to see prostate cancer underfunded compared to cancer's average given that it's a) not a disease for which lifestyle is typically blamed like lung cancer and b) it's a disease that affects men, which the NIH typically overfunds: [1]. Sources are not consistent in saying prostate cancer is underfunded either: a 2021 paper describes it as the most funded cancer, which I can't reconcile with the NIH numbers. Part of the explanation probably lies in the fact that "overall cancer" also contains general funding for cancer, such as blue sky research and councelling. A 2023 paper describes prostate cancer as middle-of-the-road in terms of funding (rank 9 out of 18 per DALY, 10 out of 18 per death, Table 2). This paper also explains that 29.2% of cancer research goes into general research, which may explain much of the discrepancy between the 11,000 and the 5,700 per death. I don't think the comparison with cancer as a whole works therefore. In the paper you cite about non-profits being underfunded, prostate cancer is just below the average line too (Figure 1b, 1c). —Femke 🐦 (talk) 09:15, 9 March 2024 (UTC)
  • Thank you for looking into this! Will follow-up when I have a moment and make some changes.
  • Ok, Mirin (2021) says A recent study of the funding of 18 different types of cancers [found women-specific cancers rank poorly] in funding normalized to years of life lost, whereas prostate cancer ranked 1st. cites Spencer, et al. (2019). There the authors use NIH data up to 2014 to track funding vs. lethality trends. They say From 2007 to 2011, prostate cancer had the highest Funding to Lethality scores of all the cancers evaluated, while from 2012 to 2014, breast cancer had the highest scores. and have a neat graph (Fig. 1) showing this trend. So Mirin seems to be (accidentally?) only referring to Spencer, et al.'s data for 2007-2011. Perhaps prostate cancer's funding vs. lethality continued to fall after 2014. I have no intuition for why that would be, and I was probably too hasty writing the summary here (I had just been at lung cancer and probably adapted this without sufficient thought). The 2023 Lancet Oncology paper you linked above is great! I hadn't seen that before. I think that's the most solid basis for the section going forward. I've rewritten that paragraph to highlight a couple of numbers from the 2023 paper. Happy to hear thoughts/criticism. Ajpolino (talk) 19:58, 18 March 2024 (UTC)

Overall, I think the article is very close to meeting the FA criteria, and I will support a nomination there after the comments above are addressed :). —Femke 🐦 (talk) 16:09, 9 March 2024 (UTC)

Thanks very much for your time and effort. I've taken a swing at most of your comments. I have a few left to get to. Feel free to follow-up on anything you feel I've insufficiently resolved. Pardon my slowness this week. Just happened to catch me at a busy moment in real life. It should be letting up shortly. Ajpolino (talk) 20:36, 12 March 2024 (UTC)

Alright Femke I believe I've hit on all your points above. Please feel free to direct me to any outstanding deficiencies you see. Thanks again for your thoughtful feedback; the article is much improved for your efforts. Ajpolino (talk) 00:41, 20 March 2024 (UTC)

I'm very happy with how everything turned out! Learned a lot from the review, not only about prostate cancer, but also more generally about writing medical articles to FA, which will come in handy in the work on ME/CFS we're planning. —Femke 🐦 (talk) 19:45, 20 March 2024 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.