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Testosterone replacement and prostate cancer: Is therapy safe?

Rating

2 Star

Testosterone replacement and prostate cancer: Is therapy safe?

Our Review Summary

This was a story about a treatment option for which there is little evidence available about harms and benefits.  The story made it seem like a good alternative for men to improve quality of life after prostate cancer treatment.  The top of the story was brimming with enthusiasm, with the quotes of caveats from clinicians indicating that this treatment is not generally considered favorably mopping up at the end.  It mentioned the results of studies which weren’t really applicable to the target population and so they were likely misleading to readers without access to the medical studies themselves.

This story failed to communicate key information for individuals making treatment decisions such as the magnitude for potential benefit and harm from the treatment, its cost, and possible alternatives.  

The story may have done a better job selling the physician’s new book than it did in informing readers with balanced information.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story provided no information about the costs associated with testosterone treatment.

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

Not Satisfactory

The benefit of this treatment, as described by the one patient interviewed, was that it made him ‘feel like a man again’.  This provides the reader with no means of determining how many men could be expected to feel better or the magnitude of improvement that might be expected.

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

Not Satisfactory

The story failed to provide quantitative information about the harms of testosterone treatment following prostate cancer treatment.  

The story stated that "Understanding the pros and cons of testosterone replacement is not easy" but then spent most of its space describing the pros without elaborating on the potential risks associated with testosterone replacement.  In addition to the prostate related risk potential, testosterone can affect the cardiovascular and respiratory systems, as well as breasts, testes, and skin.

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

Not Satisfactory

The story puts forth Dr. Morgentaler’s "theory" and his new book "Testosterone for Life" as if they were pieces of scientific evidence, which they’re not.

The story included evidence that was not germane to the topic.  The story was about the use of testosterone supplementation AFTER prostate cancer treatment.  In support of this approach, it mentioned a 2006 study by Dr. Morgentaler which found that testosterone levels were lower in men with prostate cancer.  This has little relevance about the safety or efficacy of testosterone treatment after prostate cancer treatment.

The story also stated that testosterone added to prostate cells accelerates their growth in culture.  However – it did not provide any qualifier that growth in a lab is very different than in a person and so this information is of limited relevance to a man with prostate cancer. 

The recent paper by Dr. Morgentaler provides what it describes as "anecdotal evidence" about the utility of testosterone supplementation after prostate cancer treatment.  The quality of such evidence should have been discussed to provide some context for critically evaluating this treatment.  

Does the story commit disease-mongering?

Not Satisfactory

The story is misleading, suggesting that this one man’s worst-case scenario is representative of all men treated for prostate cancer.

Having only one patient interviewed for this piece and printing his assessment of life after prostate cancer treatment (‘Life was miserable’) is disease mongering and does not provide a balanced view.  If the intent was to inform the public that life after prostate cancer is not always pleasant, it should have included some information to indicate how often this is the case.

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

Satisfactory

The story included quotes from several clinicians with relevant areas of expertise.  It would have been nice to see this information at the beginning of the story rather than at the end.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There was absolutely no discussion about other treatment options for men who have gone through treatment of prostate cancer for improving quality of life.

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

Satisfactory

It was clear from the article that not all doctors would prescribe testosterone for use by men with prostate cancer.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story portrayed the use of testosterone to treat men after they had received prostate cancer treatment as something other than traditional and therefore somewhat novel.  The story neglected to mention that the data on this treatment approach rests on what Dr. Morgentaler describes in his most recent paper as "anecdotal evidence."  Readers should have been provided with sufficient information to know that the treatment is so novel that it hasn’t been critically evaluated.

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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