PSA Test Does Cut Prostate Cancer Deaths, Study Finds

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

 While mentioning that PSA testing is rather routine practice in the US, there was no indication of its cost. Now, while the cost of PSA testing itself is relatively minimal, this was a study not just about screening but treatment.  As Dr. Otis Brawley of the American Cancer Society wrote on the ACS blog:

• “It is important to recognize that this was not only a trial of screening alone; it was a trial of screening and superior treatment. Men in the screening group received treatment at a few centers that specialized in treatment of prostate cancer. The men in the control group received standard care in their community. That is likely to account for some and possibly all of the survival benefit."

So we think the story should have included at least a nod in the direction of WHAT IT COST to achieve the result trumpeted in the headline – especially given the proliferation of expensive robotic surgical systems and newer radiation therapy techniques.  

This is a classic example of how cost gets left out of the discussion.

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

Not Satisfactory

 While doing a nice job presenting some of the data from this story about the benefits of PSA screening, additional care with words should have been employed in distinguishing between all-cause mortality and prostate cancer mortality.  The story didn’t convey that PSA screening for prostate cancer did not change the overall chance of men dying.  What this means is that there were men saved the fate of dying of prostate cancer that simply died of other causes.  This is an important oversight in reporting.

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

Not Satisfactory

Although reporting that ‘just 12 men would need to be diagnosed with prostate cancer in order to save one life’ the story neglected to follow though and examine the harm done to the other 11 men.  There are psychological consequences of a cancer diagnosis.  In addition, it wasn’t just that men were diagnosed with prostate cancer that affected the chance that they would die from prostate cancer  – at least some of these men also received treatment for prostate cancer.  There was no discussion of the possible harms that are a consequence of prostate cancer treatment.

These are not easy issues, but the story did not mention that the number needed to screen to prevent one cancer death was 293.  Those who were screened and got a false positive, perhaps leading to unnecessary followup testing like a biopsy, experienced harms.

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

Not Satisfactory

The story did a good job of presenting information about certain aspects of the study.  Information about the nature of the study (i.e. randomized trial) was included. But the article does not indicate that even 20,000 subjects is a small number for a screening trial and that the 44% risk reduction has a wide confidence interval–the true effect could range from 61% to only 18%.   These are questions about the quality of the evidence that should have been mentioned.

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

Not Satisfactory

 The story included quotes from several experts.  But we’re going to rule the story’s performance on this criterion as unsatisfactory for reasons of balance.  It’s possible to have several sources and still have an editorial imbalance in the story. 

• Allowing the lead researcher to say "Personally, I would recommend my friends check their PSAs" introduces an imbalance that is hard to overcome.  Where is a spokesman for shared decision-making? 
• Allowing the Mount Sinai urologist to assert that PSA testing is "more or less the standard to care in America" also introduces an imbalance.  Even the lead researcher says "In Europe, we have been reluctant to recommend that all men get PSA testing."  What may be the standard of care in the US may also not be the standard of care in the rest of the world and we think that’s worth noting.
• Why is there not even a mention of the evidence-based recommendations of the U.S. Preventive Services Task Force? The Wall Street Journal, for comparison, included this fact in its story.