This story reported on a recent study that found that a man’s PSA level at age 60 was a useful indicator of his risk for developing aggressive prostate cancer within his lifetime. While initially seeming to indicate that major groups concur that the decision to be screened for prostate cancer with this test should be a choice made by the individual man after discussion with his doctor, in the end – the story doles out clinical advice about when and how often men should be tested. In so doing, the comment goes beyond what was supported by the study which is problematic. In addition, although it is true that the study results reported on can be used by men to help inform their decision in terms about how to make use of their test results, the story did not appear to leave room for the man who decides against testing altogether. Nonetheless – the story provides interesting information for men about one approach to using PSA test results to inform future decisions about testing.
It is important for men to understand that that prostate cancer is not a monolithic condition. Some prostate cancer is aggressive and much of it is not. Further, there is value in recognizing that ‘catching a cancer early and treating’ is not without its downsides – namely common quality of life reducing side effects. Recognizing that there is not a one-size-fits all answer has merit to help men understand that they must weight the pros and cons for themselves to decide whether they want to be tested or not; and if they do want to be tested – when and how often.
There was no discussion of costs, though this doesn’t seem relevant to this particular discussion.
The way the study results were reported in this study, 75% of men have a PSA level at age 60 that is less than 2 meaning that their risk of having a problematic prostate cancer in their lifetime is less than 6%.
It might have been useful to provide some context for evaluating what a 6% risk means. How does it compare, for example, of a man’s chance of dying of heart disease? Or other types of cancer?
The potential harm that might occur by a man who stops screening at age 60 because his PSA level was low who might still go on to die from prostate cancer. The story provided estimates of this.
While presenting interesting insights about prostate cancer risks, the story did not include any information about the accuracy of the PSA test itself. At the very least, it ought to have indicated that there are common factors that can increase an individual’s PSA level which are unrelated to prostate cancer.
The story provided a lot of interesting information on results from several recent studies. To better enable readers to know how much credence to put on the results reported, it would have been useful to mention that the first study reported on was a case controlled study and that the European study was a randomized clinical trial.
The story implied that men with a PSA between 1 and 2 at age 60 are in some sort of limbo because the ‘advice is less clear’. The story really ought to have included the insight that these levels of PSA are well within what is considered normal. At worst, men in this category would still be predicted to have less than a 6% chance of developing prostate cancer in their future. Perhaps what is less clear is the particular experts advice about future testing, though this really circles back to the initial premise of the story – that men need to make choices about whether to undergo PSA testing.
The story did not engage in overt disease mongering.
One clinician associated with the featured study reported on and an expert in the field without direct links with the study were quoted for this story.
The story focused on the possibility of reducing the number of PSA tests a man might undergo in his lifetime to screen for prostate cancer if at age 60 his PSA level is found to be less than 1. SInce the test is run on a blood sample collected as part of the blood collected for various other types of screening and testing, the story did not make clear why reducing the number of PSA tests a man has is of importance. It goes beyond the cost of the test itself and includes the costs for biopsies and cancer treatments which would not be done. The story should have been clearer that beyond costs, reducing the number of tests may be a benefit because not only is testing itself stressful, but the more you test, the more likely you are to get an abnormal result. Even if this elevated PSA level is addressed by just repeating the test, treating a urinary infection, etc – it still adds stress and cost.
While not being explicit, the story strongly implied (correctly) that the PSA test is readily available.
This story was about a readily available test; it provided information on the results of a recent study which may be useful for some men making decisions about whether to be tested and if they so chose, at what age(s).
Does not appear to relay solely on a news release.