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A cancer quandary: Does a PSA test save lives or do more harm than good?
February 05, 2007
Some doctors believe a blood test to screen for prostate cancer saves lives. Others say it has done more harm than good by resulting in unnecessary procedures. Patients must weigh the conflicting advice.
Our Review Summary
This generally well-balanced and informative article uses one man's story to demonstrate the challenge faced by all men and their doctors who have to decide if and how to screen for prostate cancer. Stories about prostate cancer often overemphasize the 'life-saving' role of PSA testing, which is not supported by the evidence. This article makes it clear that there is still much to learn about the role of this screening test. By including quotes from providers who say they would 'rather overtreat men,' the story suggests that men who aren't convinced of the test's value would do well to find a provider willing to discuss the risks and benefits. Quotes from experts on both sides of the issue and a summary of expert recommendations provide useful context for the experience of the one man who was profiled..
The 'unsatisfactory' ratings for costs and treatment options are relatively minor issues in this otherwise balanced story.
Click on Criteria for definitions.
It's clear that the tests and treatments discussed are readily available.
The story mentions the costs to a particular health plan of PSA testing, but does not mention the costs of (potentially unnecessary) followup tests and treatments for detected cancer.
The story cites several experts who have different perspectives on the severity of prostate cancer, ranging from those who would treat all to those who are not certain that all men should be screened. This lends the story balance and gives an accurate view of the uncertainties surrounding the condition.
This story is not pegged to a particular trial or study, but it outlines what is known about how well PSA test is able to detect cancer and the uncertainty about whether screening affects mens' risk of dying from prostate cancer.
The story makes it clear that far from being a 'simple blood test,' the PSA test can trigger a series of additional tests and treatments that have definite side effects
It is clear from the story that neither the PSA test nor treatments for prostate cancer are novel.
The story notes that 5-year survival is better when prostate cancer is detected early, but does not clearly link screening to detection at earlier stages. It is noted, however, that the recent decline in prostate cancer deaths cannot be clearly linked to PSA screening.
Quotes several apparently independent sources and points of view and does not appear to have relied on a press release.
The story cites several experts who hold different views on the role and value of PSA testing, and indicates their speciality areas, which helps the reader to assess whether their perspectives might be affected by their areas of expertise.
The article only briefly mentions radiation therapy in passing, but it is another acceptable treatment option for prostate cancer, and would have been an option when the patient appeared clinically to have cancer confined to his prostate. The story said, "If true, it meant Wildes needed surgery only to remove his prostate. It would be a cure without radiation or chemotherapy." There are several misstatements in that sentence. It did not mean surgery was his only choice. Radiation was an option. But chemotherapy is not used in early prostate cancer. Hormone therapy may be an option, but the story didn't refer to that. Finally, it is misleading to say "It would be a cure." That is not known.
Total Score: 8 of 10 Satisfactory
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The website NoFreeLunch.org posts "a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information."
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.
We apply the same ten standardized criteria to the review of every story.
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Our reviewers include two former CNN medical reporters and a former editor of the Washington Post health section.