A recent study in the Journal of the National Cancer Institute injects more controversy to the question of the utility of prostate-specific antigen (PSA) testing. The study estimates that between 23 and 42 percent of cancers found with PSA testing would never go on to cause a problem or be detected by other means (i.e., by symptoms or digital rectal exam). These cancers are considered overdiagnosis because identifying them does nothing to improve the health of the man. In fact, in these cases, finding these cancers does more harm than good because the man is subjected to treatments that cause very difficult side effects, such as impotence and incontinence.
This story does a good job of describing the current study and its implications. It adequately describes the availability and novelty of PSA testing and does not engage in disease mongering. It mentions several potential harms of PSA testing and adequately quantifies the risk of overdiagnosis.
The story discusses the benefits and risks related to undergoing a PSA test–implying that no testing is an option and that this would decrease over-diagnosis. The story could have described more of the tradeoffs involved in this choice.
The story could have been improved by describing the costs of PSA testing.
The story does not mention the cost of PSA testing or the costs of prostate cancer treatment. Overtesting that leads to overtreatment has significant cost implications and should be part of the story.
The story provides percentages of the cases that are thought to be overdiagnosis, that is cancers that were found by PSA testing that would never have gone on to be detected or cause a problem if they had not been found by screening.
The story mentions several harms of PSA testing, including false positive results and overdiagnosis, both of which could lead to unnecessary treatments associated with significant side effects.
The story adequately describes the current study and the uncertainty about the use of PSA testing.
The story accurately describes the seriousness and prevalence of prostate cancer, highlighting that not all prostate cancers need to be treated, and is careful to explain what a high PSA test means.
The story quotes more than one expert who is not associated with the current study.
The story discusses the benefits and risks related to undergoing a PSA test–implying that no testing is an option and that this would decrease over-diagnosis. The story could have described more of the tradeoffs involved in this choice.
Clearly PSA testing is available.
Clearly PSA testing is not a new idea.
Because the story quotes several sources, it’s safe to assume it did not rely solely or largely on a news 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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