This week in The New England Journal of Medicine is the second of two major studies showing a reduction in prostate cancer incidence from a drug in the 5-alpha-reductase inhibitor class. The drug Avodart, commonly used to treat enlarged prostates, was shown to reduce the incidence of prostate cancer from 25% to 20% over 4 years in men with an elevated PSA but no prostate cancer on biopsy. With the results of this study, the drug maker, Glasko Smith Kline, is now seeking FDA approval for the drug for this indication. However, the results are far from a slam-dunk and the implications are controversial.
Adding to the contoversy are several factors: 1) no studies have shown a decrease in deaths from prostate cancer; 2) the side effects of the drug are significant (including a troubling finding of increased risk of heart failure); 3) lowering PSA levels is not necessarily of benefit; it just proves that the drug acts to shrink the prostate; and 4) the costs of the drug are huge – at $4 a day, it could cost up to $500,000 to prevent one case of prostate cancer (https://www.healthnewsreview.org/blog/2009/05/a-half-million.html).
This story does a nice job of describing the current study, quantifiying the benefits and discussing the controversy. It provides balance by quoting independent experts with no financial or personal interests in the results and by fully disclosing the potential harms of the drug.
There’s a big push for so-called "chemoprevention" of prostate cancer. But evidence – not intuition – must guide that push. This story did a decent job explaining the controversies.
At the end of the story, an expert is quoted accurately describing the cost of the drug as $4 a day, which is expensive given that it should be taken daily for many years. The article does note that insurance companies would not pay for using dutasteride for chemoprevention unless the FDA approves the indication. The article does note that finasteride, a comparable drug, is now available as a generic.
The story quantifies the potential benefits of Avodart in both relative and absolute terms. (However, we wish the absolute data had been described more clearly and with more emphasis.) First, the story describes the benefits in relative terms by stating that Avodart reduced the chance of developing prostate cancer by 23% in men with an elevated PSA but no prostate cancer on biopsy. Then it provides the same information in absolute terms by describing the incidence of cancer as 20% in the Avodart group and 25% in the placebo group. These two sets of numbers provide different perspective on the potential benefits of the drug.
The story does a good job of describing and quantifying the potential harms of the drug, which are significant.
The story adequately describes the design of the current study. The story could have mentioned that although the study was designed to perform biopsies on all subjects at the end of years 2 and 4–or when clinically indicated. The article did not note that 1393 (17%) of study subjects were never biopsied which could have biased study results.
Several times the story mentions that it is unknown if preventing these cancers would result in preventing deaths from those cancers. The story could have been more explicit about the fact that prostate cancer is slow growing and most men with prostate cancer die from other things. Thus, preventing low-risk cancers may not, in fact, save lives.
The story quotes several independent sources, including an expert from the American Cancer Society.
The story mentions finasteride as the primary alternative to Avodart for chemoprevention of prostate cancer.
Avodart, a drug commonly used to treat enlarged prostate, is clearly available.
Clearly, Avodart is not a new drug, however, the idea that it could be used to prevent prostate cancer is relatively new.
Because the story quotes experts other than simply the study investigators, the reader can assume the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
We’ve written about the hype of liquid biopsies for years (see link in comment below). And now this…. https://www.statnews.com/2022/01/12/medicare-shouldnt-cover-liquid-biopsies-early-cancer-detection/
Case counts still matter. “(There) are stories that may not be told adequately if only hospitalizations and deaths are emphasized.” @garyschwitzer interviewed by @dbauder of @AP. https://apnews.com/article/omicron-changing-news-outlets-covid-data-da9272f7c4c8a109c3bfb56bed9e9c76
My friend Gary @garyschwitzer wrote to his city council representative in a Minnesota town about a Viva Las Vegas event scheduled for January.
The response he got seems to perfectly capture where we are now.
https://www.healthnewsreview.org/2021/12/2021-ends-with-covid-craziness-in-sports-and-politics/
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like