The imbalance in the story occurred in that it only discussed the perils of failing to treat prostate cancer aggressively enough because of a treatment course based on clinical staging. But the flip side is equally important and the story did not mention the pitfalls of treating a prostate cancer that was not destined to be problematic.
Understanding the aggressiveness of a prostate cancer is crucial for making decisions about whether and how to treat the cancer. This story could have done a better job in reminding readers that some prostate cancers are aggressive disease but that most are not.
There was no discussion of costs. What does clinical staging add to a man’s bill? Especially if this is a “wakeup call to those who are over-relying on the clinical staging system” – as the story states – what impact could that have on costs?
The story covered a study that raised questions about clinical staging being “worthless.” The story made clear that there were serious new questions about the absence of benefit.
The story mentioned that doctors ‘erred 35% of the time’ with clinical staging and this leads doctors to conclude that a given prostate cancer “is less serious than it really is.” However – this is only half of the story. There’s also a significant harm that occurs from overtreatment of lesions that were never destined to be problematic. To be balanced and complete, the story should have mentioned this as well because it is another important problem.
For example, a MedPageToday story addressed this issue: “For those men with prostate cancer found to have been staged incorrectly, the assigned clinical stage was too low 55.1% of the time — and too high in 44.9% of cases.”
We never learned how the study was done and, thus, were given no basis to judge the quality of the evidence.
By comparison, a MedPageToday story addressed limitations of the study:
“Limitations of the study included the differences among clinicians in their levels of skill in physical examinations and imaging interpretations, and the fact that the current analysis only included patients who underwent radical prostatectomy.”
There was an imbalance in the story in that it only discussed the perils of failing to treat prostate cancer aggressively enough because of a treatment course based on clinical staging. But the flip side is equally important and the story did not mention the pitfalls of treating a prostate cancer that was not destined to be problematic.
So, in effect, the story only focused on the aggressive prostate cancers but didn’t remind readers that most prostate cancers are not.
An expert in this field without ties to the study reported on was quoted in this story.
The story included one expert’s perspective that the new study questioning the value of clinical staging “may not make much difference in the real world” because other tests are used like the Gleason score and the percentage of biopsies that are positive for cancer cells. So some attempt was made to put this into the context of other tests that are used.
The story states that clinical staging is “widely used” and that 10 years ago the American College of Surgeons “decreed that doctors should use these types of clinical staging tests to help decide how to treat cancers.”
The story reported that clinical staging has been recommended for use by the American College of Surgeons Commission on Cancer for the past 10 years and gave one doctor’s statement that “this is the first study that quantifies the magnitude of the inadequacy.”
Does not appear to rely solely on a news release.