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Advances in treatments for enlarged prostates

Rating

2 Star

Advances in treatments for enlarged prostates

Our Review Summary

While this story provides a lot of potentially interesting information about means for managing problems associated with benign prostate hyperplasia, it falls short of best journalistic practice on a number of counts.

  • It engages in disease mongering with the underlying thought that all enlarged prostates seemingly need to be treated. 
  • It failed to provide a framework for the results presented. 
  • It didn’t mention side effects associated with the treatments. 
  • It did not distinguish between those treatments which have been used now for a several years and those which are experimental.
  • While acknowledging that the medications might be prescribed for ‘the rest of their lives’, it didn’t provide much insight about the length of time the treatments discussed had been studied and whether their effectiveness or benefit/harm ratio changes over time.
  • It also did not provide much quantitative information about the magnitude of benefit that might be expected or the proportion of men that could be anticipated to reap those benefits. 
  • The story did not fully describe the various clinical and quality-of-life outcomes measured in the treatment trials. 
  • Another omission was that the newer medications–PD5 inhibitors and Botox–are uNPRoven (based on clinically meaningful, long-term outcomes), quite expensive, and associated with important complications.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no mentioned of costs – and that’s a big issue.  The costs of 5-alpha reductase inhibitors ($3/pill) and PD5-inhibitors (> $10/pill) are rather high compared to alpha blocker such as terazosin and doxazosin ($0.5 to 1.5).  Avodart and Tamsulosin are not more effective than finasteride (now a generic) and terazosin/doxazosin, just newer and more expensive.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

While discussing the symptoms associated with benign prostate hyperplasia, it provide little quantitative information either about how common the various types of symptoms are or the extent to which the various medications and medication combinations relieved these symptoms. 

The story also did not provide data on the proportion of men who benefit, the magnitude of treatment benefit for symptom relief, quality of life, or preventing complications from BPH progression.  The only other evidence was that Botox reduces prostate volume by 15%–a finding of uncertain clinical significance. The story did not explicitly note the most clinically important benefits of preventing BPH progression–reducing the risks for surgery, renal insufficiency, and urinary retention. 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story did not mention any harms that might be associated with the use of 8 of the 9 medications discussed (though the description of the tolterodine study does note the potential for urinary retention); nor any possible harms associated with combined use of the various medications mentioned.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story mentioned a number of studies and extrapolated results from studies with one drug to others using a different drug, albeit of the same class.  It is incorrect to assume that all drugs within a class will have the same magnitude of benefit, or even the same harms associated with their use. 

Does the story commit disease-mongering?

Not Satisfactory

This story engaged in disease mongering.  It leads with the concern that with increasing age, men experience a steady enlargement of the prostate gland.  While this may be the case, it is not always a condition that mandates intervention.  The story then goes on to explain about the symptoms of benign prostate hyperplasia explaining that there are bothersome symptoms and serious symptoms.  Yet the reader is not given any information that would enable them to gauge how often the more serious symptoms arise.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story referred to the results of several previously published stories.  It included a comment from one of the authors of a high quality study published in a peer reviewed  It also made reference to the results to be presented at an upcoming meeting that are from a drug company funded trial. It included a comment from one of the authors of that yet to be presented study.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentioned that surgery used to be the gold standard of care for benign prostate hyperplasia but that it is now commonplace for medications to be used to treat symptoms and prevent progression of benign prostate hyperplasia.

The story did not mention that it is not always necessary for benign prostate hyperplasia to be actively treated.  This is a significant oversight. 

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story mentioned 9 different medications, included the scientific name for most but not all along with a trade name.  However, although there are direct to consumer advertisements for many of the medications mentioned, the story did not explicitly state whether these medications were approved and whether they were prescription or over-the-counter preparations.

Does the story establish the true novelty of the approach?

Satisfactory

The story was informative about noninvasive approaches for treatment of the symptoms of benign prostate hyperplasia.  However, most of the story focused on drugs that have been in use for years and cited studies 2 – 5 years old. 

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a press release.

Total Score: 3 of 10 Satisfactory

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