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Study disputes wait-and-see approach to prostate cancer
December 13, 2006
A large new study is challenging the common practice of recommending that older men forgo treatment for early prostate cancer and instead wait to see whether the malignancy progresses.
Our Review Summary
The article describes a new study which suggests aggressive treatment with surgery or radiation may benefit older men who were traditionally thought not to benefit (or benefit as much) from these treatments, due to their life expectancies. The article does provide some context around the nature of early prostate cancer, including the controversy over whether or not to treat it, but still seems to exaggerate the problem of prostate cancer. The article also describes the nature of the latest evidence, but seems to overstate the evidence in places ("...treatment offered a clear advantage") and lacks appropriate interpretation of the data, which is biasing in the direction of treatment. The research is observational and the story does caution readers that more research is needed to confirm these findings.
But overall the story seems tilted toward benefits of treatment, rather than caution about needing more research to confirm these findings. The story also obtains several independent sources to comment on the findings and acknowledges that not all experts agree on what the latest findings tell us. Other limitations including reporting relative risk reductions vs. absolute risk reductions, minimizing harms of treatment by not providing estimates of how frequently these occur, and not providing any cost information.
Click on Criteria for definitions.
The article states that the study followed men who chose aggressive treatment (either surgery or radiation) or observation (also known as watchful waiting) for early prostate cancer, indicating these options are currently available to manage early prostate cancer.
The article does not provide any cost information, and there are clearly wide variations in costs among the various prostate cancer treatment options.
The article does provide some context about early prostate cancer, including numbers of men who are diagnosed with or die from the condition, as well as the fact that many prostate cancers are slow-growing and may never cause harm before a man dies of something else.
The article describes the study as a database study in which men who chose various treatment paths were followed over time (which means it cannot be a randomized trial). Astute readers might be able to tell this is an observational study. The article describes some of the study limitations and states that additional research is needed to verify these results. However, the story does not appropriately interpret the evidence, which seems biasing (toward treatment). Errors include "30% less likely to die" (All will die sometime. Time frame - within 12 years - was not cited in second paragraph.) and "...indicating a clear advantage" (Not true). Although the author of the study says "we adjusted for as many of those differences as we could," we are still left with the limitations of an observational study. This story seems to hype the results which were not that impressive, given all the limitations associated with the study. But, the study is interesting and warrants additional research, as was noted in the article, and the tone could have been more in that direction, rather than the "treatment can prolong older men's lives" approach.
While the article does mention some harms of aggressive treatment, impotence and incontinence, it doesn't provide readers with any context around how often these occur or how troubling men may find these. There are qualitative statements telling readers that quality of life can be affected, but overall, the seriousness of treatment side effects seems to be minimized.
It's clear from the story that it is reporting on established treatments - surgery, radiation, or observation (watchful waiting).
The article only provides relative risk reductions when absolute risk reductions are best (and are provided in the study findings). The article also claims that the study findings "indicate that treatment offered a clear advantage," which is premature since this is not a randomized trial. The quote from an "expert" (the story gives no information about his expertise) is misleading: "This debunks the idea that older men do not benefit from treatment." Clearly, the study is completely insufficient to 'debunk' watchful waiting as a treatment option for prostate cancer, especially in older men.
Because the story relied on a number of independent sources, it is safe to assume it did not rely solely or largely on a news release.
The article provides multiple sources of information, some of whom appear to be independent of the current study. The sources also provide a range of opinions about what the latest study means, which adds balance.
The study does describe the three main treatment options for early prostate cancer: surgery, radiation, and observation. While more information about surgery or radiation may have been helpful, overall, the article does describe the main choices and especially provides context about where observation may fit into the list of choices.
Total Score: 6 of 10 Satisfactory
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