This is one more story based on a presentation given at a scientific meeting. Reporting on such talks has pitfalls which we’ve written about. The information is at best incomplete and has not been subjected to the routine scrutiny provided by the medical community in a published form. This type of reporting rarely presents a true picture of the study results and more often than not serves to mislead the reader.
The story did note that the study drug did not reduce the likelihood of developing the more aggressive tumor types in the study participants – although – in a cheerleading manner, framed this as “a relief”!! However, this fact was not provided adequate attention leaving the casual reader with an overly optimistic impression of the study results. The brief length of follow up (4 years) should have been explicitly pointed out lending credence to the argument that the drug may merely postpone rather than reduce the occurrence.
Thankfully there were two skeptical perspectives included, but there could have been many more.
Other weaknesses:
The story included a clear statement that the cost was $3 per pill. This is adequate if a single daily pill is assumed to be the prescribed regimen. But to be clear – it is necessary to indicate how often the pill would be taken. The $3 price tag belies the fact that it will cost society a half million dollars to prevent a single case of non-aggressive prostate cancer based on the study results. The study did not demonstrate a reduction in aggressive tumors. Nonetheless, we’ll give the story the benefit of the doubt on this criterion. We want to be reasonable with our reviews, but we also think that anyone who sees these numbers would want the full picture, and we think journalism needs to elevate to that level of sophistication.
The benefit discussed in the story was a lower chance of being diagnosed with prostate cancer. It failed to include a clear statement about how this change in diagnosis actually results in a benefit. To understand this benefit, it is first necessary to understand the likelihood of a false positive (the test indicates prostate cancer when the man actually does not have prostate cancer). The second piece of information needed to understand the potential for benefit is that many prostate cancers found with biopsy would not grow beyond the prostate in the man’s lifetime – which means that they don’t need to be treated in order to prevent the man from dying of prostate cancer.
Although the story did include comparative percentages of men who were diagnosed with prostate cancer in the groups who did and did not take the medication – the story should have done more to highlight the observation that the drug did nothing to affect the percentage of men with aggressive prostate cancer (which was reported to be 7% in each group). It actually stated that this finding "was a relief." To whom?
The harms of treatment were mentioned in passing, indicating that some men had trouble having an erection. Information about the percentage of men treated with either dutasteride or finasteride who experience sexual dysfunction needed to be included in order for readers to judge whether the risk of this harm was low or high.
The story mentioned that the results reported on had been presented at a meeting and that the study had been funded by the manufacturer of the drug.
But the true significance of that context may not come through to readers. The story is based on the comments made at the annual meeting of the urology community. The study results have not been published nor have they been subjected to peer review. What is being presented are the positive highlights of the study results to date and not the complete story. It should be obvious that reporting based on an incomplete disclosure of information is likely to lead to erroneous conclusions. The fact that Avodart appears to do the same thing that other drugs in its class do does not seem to be newsworthy. There is nothing earth shattering about the results that required early dissemination of incomplete information.
Five clinicians were quoted in this story.
At least the story included two skeptical perspectives. They could have found many more.
The story mentioned two prescription drugs that appear to change the chance a man’s PSA test results will suggest he has prostate cancer.
The story failed to discuss the option of choosing not to have a PSA test which also reduces the chance of being diagnosed with prostate cancer.
The recent publication of two studies has shed additional light on the value of the PSA test as a screening instrument. Given the debate over the value of the test it seems reasonable to have mentioned the test and the controversy in the study. The choice of a PSA test for men over 50 years of age (or now 40 years of age if you follow the recommendations of the American Urologic Association) is one that should be discussed and a decision made based on the individual’s circumstances. A positive test result may or may not mean anything clinically. The decision to be treated with a drug to prevent the development of a non-aggressive type of prostate cancer needs to be made with the full disclosure of risks and benefits. The issue is complicated and deserved a better airing than simply naming other available drugs.
It was clear that the story was about a different possible use for a drug "already sold for other prostate problems." But the story never stated that Avodart wasn’t approved for the new use and it didn’t say anything about any company plans to submit data to request such new and expanded approval. Stories need to keep readers’ lack of knowledge on such matters in mind. This isn’t obvious to everyone reading such a story.
The story indicated that a second drug, dutasteride, now joins finasteride, in the category of drugs which shrink the prostate and reduce testosterone levels which also appears to reduce the chance of being diagnosed with and perhaps of actually having prostate cancer.
Does not appear to rely on a press release.
However, since the study has not been published, has not been subjected to peer review and is incompletely reported, the sole source of information relative to the study results was a presentation made at a urology conference. While technically satisfactory, the reliance on the objectivity and completeness of a presentation by the authors at a national conference seems misplaced. See our primer on news coverage of presentations at scientific meetings.
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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