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PSA Test Does Cut Prostate Cancer Deaths, Study Finds

Rating

3 Star

PSA Test Does Cut Prostate Cancer Deaths, Study Finds

Our Review Summary

 This story reports on the results of one study examining the impact of using PSA testing to screen for prostate cancer.  Two significant factors were not  mentioned in this piece.  

  1. Missing from this report was the finding 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.  The failure to distinguish between all-cause-mortality and prostate cancer mortality is an important oversight in reporting.
  2. Although the story did mention that 12 men needed to be diagnosed with prostate cancer for one man’s life to be saved, it failed to consider the implications for the other 11 men, at least some of whom will undergo treatment and possibly have problems with sexual function, urine control or both – without it having any impact on their risk of dying of prostate cancer. And 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.
By neglecting to balance the potential for benefit with the potential for harm, the story promoted PSA testing rather than accurately reporting about the study results.  The story should have provided additional context for understanding the broader perspective.

Lastly – the story cast the study being reported on as being important new results about which ‘there has been a lack of knowledge’ when the study results are from just one site of a large multicenter European prostate cancer screening trial that previously (March 2009) reported a survival benefit with screening  – though of a lesser magnitude.

 

Why This Matters

In order to understand the value of screening for prostate cancer, the potential for harm as well as the chance for benefit from treatment need to be considered – and reported.  

Criteria

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 commit disease-mongering?

Satisfactory

 There was no overt disease-mongering.

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.

Does the story compare the new approach with existing alternatives?

Satisfactory

 The entire story was about whether PSA screening is better than no screening.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

 The story accurately reported the widespread use of the PSA test to screen for prostate cancer in the U.S.

Does the story establish the true novelty of the approach?

Satisfactory

 The story accurately reflected that PSA testing for prostate cancer is not new and that there has been an on-going debate about the benefit of PSA screening.

Does the story appear to rely solely or largely on a news release?

Satisfactory

 The story does not appear to rely on a news release.

Total Score: 5 of 10 Satisfactory

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