In this 3-year study of more than 2,500 men with prostate cancer, researchers compared how these patients rated their quality of life after treatment by surgery, radiation or active surveillance.
The study found that patients who chose active surveillance reported fewer side effects, but the release disappoints with a lack of numbers and precision. The release does not even tell us the number of participants in the study. Since this is a very timely study about a widely discussed topic, we wish the release had provided numbers and context.
An estimated 250,000 men are diagnosed with prostate cancer in the United States each year, according to the National Cancer Institute, and about 80 percent of those cancers are localized — meaning the disease has not spread from the organ. These patients deserve clear information on the risks to their quality of life from surgery and radiation, as well as potential benefits.
The emotional impact of a cancer diagnosis was not examined in this study. Previous research has suggested that emotional distress is an important predictor of men opting for surgery after receiving a prostate cancer diagnosis. Because of the length of the study, the risk of death from prostate cancer following any treatment can not be concluded. As the release notes, that will require studies lasting 10 years or more.
Both individual patients and society-at-large have a lot to gain or lose from the way prostate cancer is treated, as discussed in this Journal of the National Cancer Institute economic analysis.
Typically, we are asking that a release tell us the “cost” of a therapy or drug, but in this case, we wish the release had given some estimate of the cost savings from active surveillance for patients vs. surgery or radiation or both. This is an important point for both individual patients and the broader society since the population of men with prostate cancer is growing and most are likely to be on Medicare.
The release did not provide many numbers. For example, it reported erectile dysfunction and urinary incontinence as “more common” in men treated with surgery than radiation, but did not give a quantity for the “more.”
The release did include a numeral in this sentence, but it wasn’t very enlightening: “Urinary incontinence was reported as a moderate or big problem in 14 percent of men three years after surgery compared to 5 percent of men who had radiation,” Barocas said.”
The study compared benefits and harms for three different situations: surgery, radiation and surveillance.
In neglecting to provide us with the number of patients studied the release doesn’t establish the quality of the evidence. We want to emphasize that the study itself, which included more than 2,550 men that were followed for 3 years, appears to be of high quality. But the release did not demonstrate that to the readers.
The release also omitted some limitations of the study. One of the main ones is that the study used an observational cohort (a like group followed over a period of time), rather than an experimental design that would show cause and effect, so there may be other unmeasured factors influencing the results. In addition, the study captured patient outcomes through surveys. Surveys after the fact are subject to recall bias. As well, the number and severity of side effects after 3 years may differ by treatment, “and 3 years is inadequate to estimate oncologic outcomes,’ according to the study. Further, the quality of care each individual patient received could influence outcomes.
There was no disease mongering. Instead, the release provides some encouraging context on the use of all three therapies: “Three-year survival from prostate cancer was excellent in the study at over 99 percent for patients regardless of whether they chose surgery, radiation or active surveillance.”
The release names the grant sources for the research. It would have been better if the release had also stated (as the study did) that there were no conflicts of interest among the authors.
The study was about comparison of alternatives and the release did a good job explaining what the alternatives were — surgery, radiation and active surveillance.
The release doesn’t say so explicitly but it’s generally understood that all the treatments studied are widely available and applied.
The release did not make a strong claim of novelty. It states, “This study shows that, despite technological advances in the treatment of prostate cancer, both surgery and radiation still have a negative effect on quality of life.” That’s not a new finding, but what makes the study newsworthy is that it compared the degree of side effects associated with each treatment.
In addition, the published study states that it was designed to be more diverse, representative and more broadly applicable than former studies.
“In contrast to previously published studies, this study may be more generalizable, since the cohort is racially diverse, population based, and includes a range of disease severity.”
That would have been good to include in the release.
We found no unjustifiable language.