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Rapid Rise in PSA Levels a Poor Predictor of Prostate Cancer: Study

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4 Star

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Rapid Rise in PSA Levels a Poor Predictor of Prostate Cancer: Study

Our Review Summary

This story did a few things better than its AP competition:

  • a bit better evaluation of the evidence
  • much more explicity addressing the option of not being screened at all.

But AP did a better job quantifying harms.

Neither story discussed the costs of PSA tests or provided estimates of the costs for following up an increase in PSA with a biopsy. These are significant cost issues, which warranted at least a line in the stories.

 

Why This Matters

PSA velocity was initially recommended to help men with abnormal PSA values (> 4) make decisions about whether to undergo biopsy because most of these men don’t have cancer. Because most elevated PSA values are false positives, PSA velocity could help men avoid unnecessary biopsies. However, recommendations began emerging to use PSA velocity to guide biopsy decisions for men with normal PSA values. No evidence ever supported these recommendations and now a well-designed analysis clearly indicates that using PSA velocity in men with normal PSA values will lead to even more unnecessary biopsies.

It was also important that this story dropped back and discussed the option of not being screened at all – thanks to the contribution Dr. Otis Brawley of the American Cancer Society made to the story.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story did not discuss the costs of PSA tests or provide estimates of the costs for following up an increase in PSA with a biopsy. These are significant cost issues, which warranted at least a line in the story.

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

Not Satisfactory

The story didn’t quantify the potential reduction in biopsies.

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

Not Satisfactory

The competing AP story was much better on this point, reporting that using rising PSA levels, 1 in 7 men would have a prostate biopsy as compared with 1 in 20 men based solely on high PSA level. This suggests that change in PSA level results in 13/20 unnecessary prostate biopsies.

The story could have provided more detail on some of the possible complications resulting from prostate biopsies.

It did mention anxiety from tracking PSA levels over time.

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

Satisfactory

The story included the number of men that were studied and that the men studied had taken part in a prostate cancer prevention study.

Better than its AP competition, the story mentioned that the study of PSA velocity only included those individuals who were in the placebo arm of a drug trial.  

But neither story explained that this was a highly selected population – men with abnormal digital rectal exams and PSA values greater than 3 were excluded. This information is important for understanding how generalizable the result of the study might be.

 

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

Two independent sources were quoted.

Does the story compare the new approach with existing alternatives?

Satisfactory

 The story contrasted using change in PSA level versus simply the PSA level for their impact on prostate biopsy recommendations and subsequent diagnosis of prostate cancer.

More importantly, much more explicity than the competing AP story, this story (through the words of Dr. Otis Brawley of the American Cancer Society) addressed the option of not being screened at all.  Excerpts:

  • “The whole issue of prostate cancer screening — including the PSA test, the digital rectal exam and PSA velocity — has been controversial, said Dr. Otis Brawley, chief medical officer of the American Cancer Society (ACS).                                                                                                                                                                                                                                                         Part of the difficulty is, while current screening methods are good at detecting cancer, they can’t distinguish between aggressive, life-threatening prostate cancers and those that are slow-growing and relatively benign. And many prostate cancers are just that — of little risk to men during their lifetimes, Brawley said.                                                                                                                                                                                                              Current ACS prostate screening cancer guidelines recommend that men make an informed decision with their doctor about whether to be tested for prostate cancer. “Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment,” according to the ACS.”

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

Satisfactory

It’s clear from the story that PSA tests are readily available.

Does the story establish the true novelty of the approach?

Satisfactory

The story made clear that the study was examining the relative merit of relying on a change in PSA level as indicated in some current guidelines.

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

Satisfactory

Does not appear to rely solely on a news release.

Total Score: 7 of 10 Satisfactory

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