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.
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.
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.
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.
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.
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.
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.
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.
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.
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 not appear to rely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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