One of our medical editors – who follows prostate cancer research very closely – said she read this story several times and was still confused by what she called a “convoluted” approach.
The story was about a change in the American Urological Association’s (AUA) past recommendation for annual PSA blood tests after age 50 to screen for prostate cancer. Instead, the AUA says men should be offered a baseline PSA test at age 40, and follow-ups at intervals based on each man’s situation.
The story was unclear about the extent to which men would stand to benefit or be harmed from PSA testing.
A strength was that it included perspectives from NIH’s Dr. Barry Kramer – that there is no proof that a baseline test will save lives. And from the American Cancer Society’s Dr. Otis Brawley – "I am very concerned that the urology community and the American public may think there’s more value in PSA than there actually is."
But a weakness is that the story kept going back to the well of quotes of people who promote SOME screening……
…..without ever talking about NO screening as a legitimate option.
That’s a big failing – because the story failed to connect the dots to show that the AUA’s new recommendation is still out of line with other groups, including the US Preventive Services Task Force which states:
The story included no information about the cost of a PSA test.
While one clinician quote asserted that "Everyone has to get screened," the story did not provide readers with any quantified information about the impact screening would have on improved outcomes (e.g. decreased incidence of prostate cancer death, decreased incidence of symptoms of prostate cancer, increased number of years lived).
The story did include numbers to give the reader some indication of how various PSA levels at specific ages related to the chance of future risk of prostate cancer. What the story did not explain was how effectively this information could be used to improve outcomes.
Although the story mentioned the harm of ‘overdiagnosis’, there was no attempt made to quantify the percentage or number of men who are ‘overdiagnosed’ by PSA testing. The story actually failed to provide a clear definition of the term ‘overdiagnosis’. While the story did mention in an earlier section that annual screening lead to unneeded biopsies and treatment, this is an incomplete explanation about the harms associated with overdiagnosis. Overdiagnosis also means undergoing time consuming or painful treatment as well as encountering commonly occurring side effects. This would have helped the reader grasp the significance of the discussion around the value of PSA testing.
The story seems to suggest that by simply having longer screening intervals than annual screening that the harms of PSA testing are diminished, which is not the case.
The story did not do an adequate job distinguishing among strength of the observations presented. In one sentence, it stated "two big studies concluded that annual PSA tests do little to prevent deaths from prostate cancer". The next sentence went on to say that "new studies at the urology meeting suggest ways" that PSA tests can be used.
It is significant that the ‘big studies’ were randomized clinical trials, whose results and conclusions have undergone peer review and have been published. The ‘new studies’ were presented at a meeting have not yet undergone scientific scrutiny by colleagues. It is important for readers to understand this is an important difference and that the results of the two should not to be given the same weight of consideration.
In addition – the story did not provide a cogent explanation of how a ‘screening test’ and a ‘baseline test’ differed from one another. Changing what you call the test does not change the consequences that follow. Dr. Kramer from NIH spells out that there’s really no difference between "baseline PSA" or "PSA screening" – both can cause same harms, and both lack convincing data of benefit, but the quotes from Dr. Kramer seem buried or at least diluted from the many quotes of AUA members, such as "Everybody has to get screened at some baseline."
The story stated the number of new cases of prostate cancer and the number of prostate cancer deaths per year but said nothing about the discrepancy between the number of cases diagnosed and the number of deaths. Without providing a context, this detail is an example of disease mongering. All of the focus on "the PSA score" – and on rising numbers of one’s score – failed to connect the dots in the most meaningful way.
Quotes from a number of investigators and experts in the field were included as a part of this story.
There was no discussion of avoiding PSA tests altogether – a legitimate option that was totally overlooked.
The story failed to include any mention of the importance of shared decision making with respect to PSA testing. The story could have helped men think more clearly about how they value the tradeoffs of potential benefit vs. potential harm of PSA testing – at all – baseline, annually, or on a less frequent schedule.
It’s clear from the story that PSA testing is a readily available blood test.
The story did not imply that PSA testing was new or novel. What is new are the new guidelines which will no longer recommend yearly PSA testing for all men over the age of 50.
Does not appear to rely on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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