This story, based on a paper in a radiation oncology journal, never tells readers whether the radiation treatment that followed the test in question helped the men in the study in terms of cancer control. Big picture missing.
The story reports on interesting and important research, but the story gets satisfactory scores on less than half of our criteria.
Treatment complications, particularly erectile dysfunction and urinary incontinence, are common and bothersome outcomes from prostate cancer treatment. Because complications differ by treatment modality, men’s concerns about complication risks can influence treatment decisions. Providing additional information can better support informed decision making.
Not addressed. Genomic analyses, although becoming cheaper, still may cost around $1000.
Despite the headline that states that “DNA markers may predict impotence after prostate cancer,” the story correctly indicates that any benefit from the work is speculative; even if these markers are confirmed to be valid, there are currently no available treatments to target the genetic abnormalities. However, another underlying issue, which was not addressed, is whether radiation treatment benefited men in terms of cancer control.
Not applicable; given that this is still an unproven strategy, there are no data for harms.
The description of the sample size is misleading which means that the story did not sufficiently address the quality of evidence. Even the Mount Sinai press release indicated that investigators conducted a 2 part study–first to derive the panel of abnormalities in a sample of 235 subjects and then to confirm the validity of the markers in another 230. Furthermore, the story did not provide any data on the proportion of men who developed ED or the magnitude of the risk associated with the genetic markers. The story did correctly indicate that results need to be confirmed in a large-scale observational study before the tests could be considered for clinical practice.
No disease mongering. Prostate cancer is the most frequently diagnosed cancer, most men are diagnosed at an early stage and subsequently undergo active treatments–which carry substantial risks for complications. However, the article could have cited estimates for the risk of erectile dysfunction following treatments.
The article does not clearly identify whether the sources are independent (one is a co-author, the other is not).
Alternative treatment approaches are not discussed. Presumably all subjects have cancer confined to the prostate and are eligible for attempted curative therapy (surgery or radiation). However, a substantial proportion of early-stage cancers are low-risk–and do not necessarily even require treatment. These men face no risk for treatment-related erectile dysfunction. The alternative active treatment–surgery–is actually much more likely than radiation therapy to cause erectile dysfunction. The other major issue regarding treatment alternatives is whether patients would achieve better cancer control–a potentially more important outcome for patients than the complication risks.
The article clearly indicates that this work is experimental and would require extensive validation before it could be considered for clinical practice.
Using genetic markers to determine the risk of treatment-related complications is novel.
There’s no evidence that the story relied solely or largely on the Mount Sinai press release.