This story is based on a "news briefing" by a company spokesperson about purported promise for improved detection of prostate cancer using the company’s product. The enthusiasm of the piece failed to address the larger questions about whether the test actually improved the outcomes seen in the men who were tested. There did not seem to be a critical appraisal of the information reported, the value of the results presented nor was there any apparent effort to put this into the context of all the other research to find the truly bad prostate cancers.
This story doesn’t demonstrate the knowledge that a product isn’t necessarily valuable just because a company spokesperson says it is.
There was no discussion of costs, which might be explained by the fact that the test is not yet available in the US. However, since it is commercially available in several European countries, those costs should have been mentioned at the very least.
The story did mention that biopsies for prostate cancer can result in infection and that the test might have utility in that it might reduce the number of biopsies done.
In general, the story focused on enhanced ability to diagnosis prostate cancer. But the story failed to question the value of the test in providing any long term benefit to the men involved. Did it result in fewer prostate cancer deaths? Did it result in fewer cases of metastatic disease? The story did not examine these important features for determining value and benefit.
There was no discussion of any possible harms such as diagnosing prostate cancers that won’t affect the health of the individuals or missing prostate cancers that should have been treated.
The information in this story was reported as coming from a news briefing held in advance of an upcoming cancer meeting. There were no caveats about drawing conclusions from non-peer-reviewed results that have been trumpeted at a news briefing.
PCA3 is one of many tests that have been evaluated to reduce the number of unnecessary biopsies. Typically, the tests are performed before the biopsy to see whether it could improve the perfomance of PSA. However, this study used the PCA3 to predict cancers diagnosed 2 years later. These data are difficult to interpret because we don’t know how many of the original 1072 men actually underwent the biopsy two years later. We also don’t know whether the PSA tests results changed over the two-year period–which often drives decisions to repeat a biopsy–meaning that the PCA3 might not be providing much useful additional information.
Finally, in reporting on the results presented, the story neglected to mention that this was a sub-analysis of the data collected.
While the story mentions that men with higher PCA3 scores are more likely to have aggressive cancers, there are no data reported to support the claim. A major problem was that the story failed to provide any information to the effect that not all prostate cancers are likely to cause harm. Without including this counterpoint, the story does, indeed, disease monger about prostate cancer.
The story mentioned that the study was funded by the company that makes the test in question. The quote from the clinician from a for profit cancer treatment center barely qualified as an independent source.
There was no discussion of the myriad of molecules that are currently being investigated for their potential to provide better information for detecting the bad prostate cancers.
The story does mention that this test is not approved for use in the US but that is approved for use in several European countries. It closes by indicating that the company that makes the test is hoping to file for approval later this year.
This story failed to mention that peer reviewed studies examining the utility of PCA3 have not found it to be significantly associated with progression of prostate cancer. Reporting on the results of this recent study, based on information from a company spokesperson without examining what others may have found to date is inadequate.
The story reported that the information it contained was based on a presentation that occurred prior to the start of the 2010 Genitourinary Cancer Symposium. It does not appear to include information from independent sources. This is news coverage via news conference – far from best practice.
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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