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Simplifying the Decision for a Prostate Screening

Rating

4 Star

Simplifying the Decision for a Prostate Screening

Our Review Summary

 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.

 

Why This Matters

 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.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

 There was no discussion of costs, though this doesn’t seem relevant to this particular discussion. 

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

Satisfactory

 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?

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

Not Satisfactory

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.

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

Satisfactory

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.

Does the story commit disease-mongering?

Satisfactory

 The story did not engage in overt disease mongering.

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

Satisfactory

 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.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

 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.

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

Satisfactory

 While not being explicit, the story strongly implied (correctly) that the PSA test is readily available.

Does the story establish the true novelty of the approach?

Satisfactory

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

Satisfactory

 Does not appear to relay solely on a news release.

Total Score: 7 of 10 Satisfactory

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