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Study Questions Prostate Cancer Screening
January 10, 2006
Two widely used tests for prostate cancer failed to save lives in a new study, adding to the debate over whether men should be screened for the disease. The study was small -- only 1,002 men -- and will not be the final word on the issue. But it may hint at what lies ahead when the results of two large studies of prostate cancer screening appear in a few years. The researchers looked at two screening tests that are performed millions of times a year in the United States: a blood test that measures prostate specific antigen, or PSA, and a digital rectal exam, the rubber-glove test in which a doctor feels for abnormalities in the prostate through the rectal wall.
Our Review Summary
The uncertainty of prostate cancer screening with PSA blood tests and/or digital rectal exams to reduce prostate cancer deaths is not new, although this report describes the latest study to find no mortality benefit with screening. Overall, the story does a great job of discussing the real issues - that despite the popularity of prostate cancer screening (millions of tests in the US each year!), the effectiveness of prostate cancer screening has not been established. The story includes a note on when we might know more based on the estimated date of completion of two large, ongoing screening trials (as opposed to observational studies like this one). One weakness of the story was that study results were not quantified; instead the findings were already interpreted for the readers who were not able to see the actual data figures.
Click on Criteria for definitions.
The story provides information on how long screening has been available. Likewise, it also states that these screening tests are performed millions of times each year in the U.S.
The story made no mention of costs, societal, personal, or otherwise.
The natural history of prostate cancer is appropriately reflected here -- that is, that prostate cancer may not kill you or even cause problems because it is often slow-growing and that screening and early treatment may do more harm than good. It tells readers in the opening lines that there is an on-going debate about screening.
The observational study design is described to readers (e.g. that two groups were chosen during a particular time period and matched). IThe story also talks about limitations--that this is a small study and that this is not the final word on screening (presumably because study is observational and not a randomized clinical trial).
The potential harms of screening are appropriately discussed, namely that screening could be wrong (false positive or false negative), could lead to further testing (biopsy), and that detection could lead to treatment which has serious side effects without knowing for sure whether the cancer would have harmed you in the first place.
The story states that results from study on prostate cancer screening are based on data from 24 through 129--the "early years of prostate cancer screening." So, the story does tell us that prostate cancer screening is not new.
Benefits, or lack thereof in this case, were not quantified. Instead, the journalist reported that men who were alive were no more likely to be screened for prostate cancer than men who were deceased. But, the actual numbers of men alive and deceased were not provided nor the proportion who indicated they had been screened or not screened.
The study co-author is quoted, but his relationship to the study is disclosed. Representatives from medical organizations that issue recommendations about prostate cancer screening were quoted as well, namely confirming the uncertainty of screening. A U.S. Preventive Services Task Force review from 2002 is also mentioned, further providing support for uncertainty of screening based on an objective review of the evidence. These sources also highlight that this uncertainty is not new.
This story does provide information on the alternative to screening, in other words, not to be screened. Phrases such as "men should decide for themselves whether to get screened" and "for some men, detecting prostate cancer early can do more harm than good" appropriately develop the concept of not being screened compared to being screened. Disadvantages/advantages of screening and not screening are discussed (potential for downstream consequences, may not help men live longer, etc.).
Total Score: 8 of 10 Satisfactory
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To help journalists cover stories responsibly, we post a list of independent experts who state that they do not have financial ties to drug or medical device manufacturers.
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