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PSA Test Cut-off Could Signal Low-Risk Prostate Cancer

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2 Star

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PSA Test Cut-off Could Signal Low-Risk Prostate Cancer

Our Review Summary

It’s little wonder that there are no independent perspectives in the story when it jumps the gun on when the data are even presented.  How could anyone react when they haven’t heard or seen the data?

We sympathize with the reporter asked to wrap up the teleconference presentations (virtually an audio news release) on the three studies.  But the story lacked:

  • a discussion of costs – in areas where cost implications are huge;
  • appropriate caveats about the preliminary nature of the evidence;
  • any discussion of potential harms from the three approaches discussed;
  • adequte discussion of benefits;
  • independent perspectives;
  • comparisons with other existing approaches.

 

Why This Matters

There is a lot of information available about prostate cancer testing and treatment this week because of a big genitourinary cancer meeting in Florida.  That doesn’t mean all the news is ready for prime time.  And, for journalists who do choose to report on the meeting, it doesn’t mean that they can or should slack off on scrutinizing the evidence or providing context for readers.  In fact, the situation demands it even more.

Failure to do so only contributes to consumer confusion and misunderstanding.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no discussion about how costs might be affected by any of the three aspects of prostate cancer testing and treatment described in this story. And all three had significant cost implications.

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

Not Satisfactory

The story did an incomplete job explaining the possible benefits to patients of the various changes to prostate cancer diagnosis and treatment that were described.

For example, the story reported the finding that surgeons need to perform 1,600 robotic prostatectomies before they are as proficient with the technology as they are with conventional surgery.  The story went on to explain that the robotic approach ‘offers surgeons three-dimensional vision and such improvements as better magnification and hand tremor filter’ but failed to explain what advantage that conferred to the patient. Does ti improve outcomes? Does it change the rates at which side effects occur?

Similarly – in detailing the potential benefit of using the medication Avodart to treat men with early stage prostate cancer, the story mentioned the relative reduction in risk of disease progression.  However without knowing how often disease progression occurs, it is not possible to make an informed decision about the value in taking this medication.

Using odd wording, the story says Avodart “may delay the progression of low-risk, early prostate cancer among men who choose a wait-and-see approach to treatment.”  Wait-and-see means wait-and-see.

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

Not Satisfactory

The potential for harm associated with adopting any of the aspects of prostate cancer testing and treatment covered in the story were not clearly or completely discussed.

For example – what are the consequences of a surgeon not being proficient with robotic surgery?

What are the side effects for the medication Avodart? How often are they seen?

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

Not Satisfactory

Although the story explained that the information came from talks that were to be given at an upcoming meeting, it did not make clear that there is limited peer review that place with findings presented at meetings.  So it is difficult to get independent perspectives on work that hasn’t even been presented yet – much less published.  And the findings should only be considered preliminary.  None of these caveats were included.

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?

Not Satisfactory

There do not appear to have been any independent sources used to verify the veracity of the information presented at the meeting or to provide context for the details reported.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story didn’t give any context on a number of points regarding alternatives. Each could have been addressed easily with a little re-wording or a few extra words.

  1. It says that men “may not need to be screened annually” as a result of the data presented.  But the US Preventive Services Task Force and the American Cancer Society already state that. The story is framed as if annual screening is the only recommended option right now.  It’s not.
  2. In describing a potential, off label use for the drug Avodart, it neglected the other treatment options available to men with early stage prostate cancer.
  3. Lastly – although pointing out that a learning curve exists for the use of robotic assisted laparoscopic prostatectomy, it failed to provide information about the learning curve associated with the non-robotic approach.

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

Satisfactory

The story reported on three different aspects of prostate cancer testing and treatment – PSA testing, medical therapy as an adjunct to active surveillance, and data about the learning curve in the use of robots in the surgical treatment of prostate cancer.

If one reads between the lines, one can infer the widespread availability of all three approaches from the story.

Does the story establish the true novelty of the approach?

Satisfactory

It is possible to infer from the story what is the relative novelty of the three approaches reported on: a potential modified schedule for PSA testing; off label use of an already FDA approved medication; and new data on the learning curve for a robotic surgical approach.

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

Not Satisfactory

The story identified the teleconference that was the source of this story and it appears to be the only source of information used in this piece. At the time this story was published, the results of the studies described had not yet even been presented. So the teleconference, with only the authors presenting, is the equivalent of an audio news release.  And it was the only source for this story.

Total Score: 3 of 10 Satisfactory

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