This news release puts readers in a worried, defensive posture right from the get-go with its headline, “Are you at risk?” It concludes with a pitch for the services of robotic prostate cancer surgeon and urologic oncologist Dr. David Samadi of Lenox Hill Hospital in New York. In between, it briefly recaps a study published in the EBioMedicine journal that apparently discovered “five different types of prostate cancer” (the study characterizes this finding, much more soberly, as “five separate patient subgroups with distinct genomic alterations and expression profiles”). The release suggests that genetic testing used in the study is better than current methods at forecasting prostate cancer progression; however, this apparent benefit is never quantified and key limitations of the study are never addressed. The tone is promotional, with links to a Fox news program featuring the surgeon quoted, a link to a “ProstateCancer911” website and the surgeon’s phone number for making an appointment for a consult. The study seems secondary at best.
About 220,000 men are diagnosed with prostate cancer in the United States annually, according to the American Cancer Society. The vast majority (98 percent) live at least 10 years after diagnosis and 94 percent are alive 15 years after diagnosis. If the cancer spreads to other parts of the body, the risk for death increases. This study highlights the possibility that men with high-risk gene profiles would be candidates for more aggressive follow-up treatment following removal of their prostates. The discussion also makes it clear that the value of these risk categories for clinical care remains to be determined. The news release would have done well to communicate that uncertainty more clearly.
The release makes no mention of the cost for an additional genetic test.
The news release states there is a benefit to having a genetic test in addition to the standard Gleason score and PSA tests. However, as discussed under the “Evidence” section, there is no data giving us any idea of the differences in accuracy or improved outcomes if patients undergo genetic testing.
The main potential harm from the test is risk misclassification (which could happen when the gene tests are applied in a larger, unselected population) resulting in either under- or over-treatment of prostate cancer. This is not addressed in the news release.
The release includes an overview of the evidence from the cited research study but doesn’t provide details on how adding a genetic test helps oncologists target treatment and improve outcomes. The study, which carefully selected a small group of patients, looked only at biochemical recurrence–which is only a weak surrogate for prostate cancer mortality. The news release fails to indicate whether the new gene tests are significantly more accurate than current clinical/pathological markers and does not indicate that biochemical progression does not necessarily herald clinical progression or mortality.
The statistics provided about prostate cancer are close to what the American Cancer Society and the Centers for Disease Control and Prevention have published on their websites. However, the headline for the release — “Are you at risk?” — seems to be blatantly exploiting the results of a preliminary research study to create worry. In addition, men with a family history of prostate cancer should do more than consult Dr. Samadi for a baseline PSA test as suggested by the news release — they should engage in shared decision-making with their provider about their options.
This release isn’t hiding any conflicts since it is openly sponsored and released by the prostate cancer specialist named. However, it almost appears as though the author hijacked a recent study about prostate cancer genetics in order to sell the physician’s services to concerned patients. Details about the study itself are minimal.
The release states that genetic testing is more accurate in predicting prostate cancer progression than either the PSA or Gleason score, but doesn’t tell us how much more or accurate or how outcomes may be improved other than a vague statement about targeting and individualized treatment.
We can’t be sure if the testing protocol discussed in the release is available or not. One might reasonably assume that genetic cancer screening for the five identified genetic types of prostate cancer is available at the specialist’s hospital. However, the release isn’t clear on this point.
The findings reported in the study seem to be newsworthy, and we’ll give credit for indicating that “new research has revealed” and “this discovery” as establishing novelty. There’s also a nod to previous research about prostate cancer genetics.
The news release makes several leaps intended to drive readers to think there’s something notable being offered, but there’s little hard evidence provided to back up the claims.
One example: “If five types of the disease exist, how does this change popular medical opinion on prostate cancer screening? This may mean that each type of the disease needs its own approach to screening, diagnosis, treatment and even recurrence,” noted Dr. Samadi.
This is misleading, since the test has no effect on screening and cannot be used to diagnose cancer (you still need a biopsy); it might lead to different treatment and surveillance strategies.