This news release is about a new method of magnetic resonance imaging (MRI) for use in the diagnosis and guiding of treatment for prostate cancer. The release claims that the new technique “measurably improves upon current prostate imaging,” is “more reliable” than existing techniques, and “provides a better target for biopsies.” No data are provided to support any of these assertions, and the original study that sparked the release included just 27 patients and should be considered highly preliminary. Even the title of that study calls the results merely a “proof of principle.”
[Editor’s note: This review was completed in January while we were still developing and honing this news releases review service. Although it’s a few months old, this review contains valuable information for those who write and consume health-related news releases, which is why we’re still publishing it.]
Prostate cancer is the leading cause of cancer deaths in men. However, some prostate tumors, even if malignant, may be slow growing and warrant nothing more than watching. If this new MRI method can help identify low-risk tumors, or assess the likelihood that a tumor will spread beyond the prostate, it would be a useful tool for guiding treatment. But the release doesn’t offer any data to show that this technique performs better than existing assessment approaches, and so its ability to justify a role for this new technology in prostate cancer treatment is extremely limited.
It is unclear if this MRI method is more, less or equally expensive as contrast enhanced MRI or diffusion MRI. It is also unclear if special equipment is necessary for this new MRI approach or if that equipment is currently common. Another cost not mentioned is the extra time needed to schedule the appointment and perform the imaging study.
The news release provides no data to justify repeated claims that this technique performs better than existing technology. And we think the release misstates the findings of the study that forms the basis for these claims. For example, the releases talks about the new technology’s ability to find small, localized tumors to guide biopsy. However, the actual study addresses only the ability of the new technology to detect cancers that have extended beyond the prostate. In addition, we found the closing quote from professor Robert Reiter, MD, about the value of the new technology, to be misleading. He says, “If by imaging we could predict the tumor grade, we may be able to spare some patients from prostate resection and monitor their cancer with imaging.” But some patients currently already enjoy the option of watchful waiting. If the biopsy grade, clinical exam, and PSA all indicate a low-risk tumor, then the patient can be offered active surveillance and avoid the need for resection.
Potential harms are not discussed. One conceivable concern is that “provid[ing] a better target for biopsies, especially for smaller tumors” might lead to overdiagnosis — finding low-risk cancers that would never cause a problem. The patient is subsequently burdened with a cancer diagnosis and complication risks related to ensuing treatment/surveillance protocols.
There is nothing in this news release that tells us anything at all about how the new technology was tested or what those tests found. Our perusal of the original study did not turn up much additional information. The article states that the new technology detected 8/9 extracapsular cancers (cancers that extend beyond the prostate capsule), and the old technology only 2/9. The authors did not present a statistical analysis, but by our calculation, the differences are not statistically significant.
This story does not disease monger and is actually tipped toward the idea that with this method, in some cases, nothing but watching and waiting is necessary. However, there is some “mongering” of the idea that MRI has a more important role in cancer management than is supported by the evidence. The release states that contrast enhanced MRI is the current “standard of care,” but many prostate cancers are not imaged (other than by ultrasound during biopsy).
The funding sources are fully listed. There is no indication of a conflict of interest.
We don’t think the story discusses the relevant comparison techniques. It talks mainly about the new technique’s performance compared with other types of MRI. But as noted above, many prostatic cancers, especially those with low PSA and Gleason scores, are not imaged at all (other than by ultrasound during biopsy). For us, the meaningful comparison of the new MRI technology would be with clinical staging, not another MRI technology. Unfortunately, such a comparison is never made or discussed.
It’s not clear from the release when or whether this technology might become available, if it’s not available already.
The news release indicates that this is a fairly new method that operates differently than other MRI methods.
As discussed above, this release harbors many unsupported claims that are not justifiable based on the evidence presented.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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