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$300 to learn risk of prostate cancer
January 17, 2008
A combination of common and minor variations in five regions of DNA can help predict a man’s risk of getting prostate cancer, researchers reported Wednesday.
Our Review Summary
On the whole, this is a well crafted story about a new genetic test that may provide men with advance knowledge about their potential to develop prostate cancer in the future. The story made it very clear that gaining this information is not without cost above and beyond the test. This new screen suffers from the same problem as the currently available methods of detecting prostate cancer, namely determining whether the cancer will be deadly or not. This is a critical piece of information because as the story points out - the treatments for prostate cancer are not without side effect. It will fall upon the men taking this test who have an indication of high risk to then make a determination of the course of action they want to pursue. It is important for them to recognize that at this point in time, we do not yet know whether aggressive treatment of early detected prostate cancer is effective.
The story allowed the test's promoters to have their say. But it offered good context and balance, particularly with the quote about the impact on a man's decision-making, which is key: “Technology today enables us to find out a huge amount of information,” Dr. Gelmann said. “But how does the public deal with this information? How does it help them make decisions? And if they make a decision, does that lead to a day, a week, a month, of life saved?”
Click on Criteria for definitions.
The story reported that the company that would be offering the test estimated that it would be available in a matter of months.
The story included a cost for the test.
A couple of the quotes border on disease-mongering when discussing the prospect of earlier prostate cancer screening - even in men in their 30s.. However, the story attempted to provide some context with expert comment questioning the wisdom in this approach.
The story was about variant forms of several genes each of which appear to confer some risk for the development of prostate cancer by the time a man reached the age of 65. It explained that this was a single study and that the contention that these alleles can be put to predictive use needs to be tested in several different populations in order to confirm the contention that they have merit for this use.
The story did include mention of the harms that are associated with treatment of prostate cancer, namely impotence and incontinence, and that the treatment of prostate cancer may not be at all necessary because not all prostate cancers are life threatening. As this is a very counter-intuitive thought (that not all cancers are deadly) it might have been emphasized more.
It is critical that people be aware that while a large clinical trial (the PIVOT study) is underway, it is not yet known whether aggressive treatment of early prostate cancer is effective or whether it may cause more harm than good. So while the effectiveness of prostate cancer screening remains controversial,it's important to note that aggressive treatment of early prostate cancer remains controversial too.
The story was clear that the genetic screen to predict risk of developing prostate cancer was not yet commercially available.
The story did provide some discussion on the conundrum presented by prostate cancer detection - namely that it is really an incomplete piece of information. The real goal is to develop a means of distinguishing between indolent and deadly prostate cancer. The risk of the former would not warrant treatment likely to render the individual impotent and/or incontinent. The risk of the latter might be worth the risk, or at least participation in active surveillance to allow for detection of a cancer while it is still localized. The story did mention this conundrum though it might have spent more time on it.
The benefit of this treatment is an early warning of a pathology that might develop; it is less clear what a man in his 30s would do with this information.
The story included interview material with several respected clinicians active in this field.
The story included comments from experts in the field who were not connected to the study reported on.
The story never mentioned that it is an option to decline screening.
Total Score: 9 of 10 Satisfactory
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