As with the NPR and AP stories we also reviewed, this story helped frame this issue in the first few lines rather than burying it at the end as so often is the case. To have an expert not involved in study quoted in the second paragraph saying “findings are not likely to be practice-changing” provides readers with balanced perspective right from the start. It was also good that the story concluded with a quote that expanded on what it means to “individualize” treatment. Unlike the concluding quote in the NPR story, this one provided language suggestive of shared decision making by adding ‘in relation to the risk stratification of disease, PATIENT DESIRES, health status, and RISK TOLERANCE”. (emphasis added) Good way to end the story.
Decisions about what, if anything, to do when facing a diagnosis of early stage prostate cancer is difficult and this story provided readers with useful information to consider.
There was no discussion of costs. Costs would include treating the double digit rates of incontinence and erectile dysfunction in these younger men who do have surgery. The surgery may help them live longer, but many, especially since younger at time of surgery, live decades with these potential harms and folllowup costs of the surgical choice. This should get at least a line in such stories.
While describing some of the differences observed in general terms without quantification, the story provided absolute percentage of men dying from prostate cancer in the two study groups.
The story then went on to explain that the difference was in the men who were less 65 years of age at the time of diagnosis. The story would have been better if it had more clearly explained this important caveat about the benefit seen.
The potential harms associated with various approaches to treating prostate cancer as well as the increased risk of prostate cancer progression and death seen in the cohort of men who followed the watchful waiting approach were discussed.
The story did a laudable job of providing information about the study reported on including the fact that the results most recently published basically expand the timeframe of followup on these men which have previously been published. It provided insight about the number of men involved in the study, how their prostate cancer was detected and that the men had been randomly assigned to their treatment group.
The story did not engage in overt disease mongering.
Two clinicians who were not involved in the study provided quotes which were used in the story.
The story included a list of the commonly available treatment options for early stage prostate cancer.
But we must give an unsatisfactory score because the story included a factually incorrect statement indicating that watchful waiting is synonymous with active surveillance. It is not. The story went on to misinform readers by indicating “watchful waiting is often recommended when a man is not expected to die of the cancer” by failing to complete the thought by explaining that the reason they are not expected to die of the cancer is because their advanced age makes it unlikely that the cancer will have sufficient time to progress to lethality OR because they have other diseases from which they are likely to succumb before there is time for the prostate cancer to be deadly.
An important caveat about how the prostate cancer in the study differed from the way in which prostate cancer is most commonly detected today in the US was explained.
The story provided a reasonable view of the novelty of the treatment options detailed in the study along with the critically important caveat that the majority of the men in the study had their prostate cancer first detected at a later state than is seen with the current screening practices in the US.
The story did not rely on a news release.