The story describes a study which quantifies the number of men who might be overtreated with surgery or radiation for prostate cancer. The story does a nice job of describing the natural history of prostate cancer, that is, that many prostate cancers are slow-growing and that many men don’t need treatment, which can have troublesome side effects. The article could have been more clear about the study design and exactly how many men were estimated to have been “overtreated.” Viewers are provided information about how many men were candidates for watchful waiting and could easily assume that any man who did not choose this approach was overtreated. Yet the actual study reports 10% of men were “overtreated.” The story also strangely reports an anecdotal story of one man who presumably chose watchful waiting. Yet this man also took a course of hormone therapy, which has multiple bothersome side effects related to depletion of nearly all a man’s testosterone (side effects like loss of sex drive). It’s confusing why this example was chosen, when this isn’t normally considered an option for men with low-risk prostate cancer.
No costs of treatment–any treatment–are described.
The study measured how many men with low-risk prostate cancer (who would be appropriate candidates for watchful waiting) had either surgery or radiation. While the aim of the study was to quantify and report an estimated figure for “overtreatment,” the story doesn’t really describe that. Viewers could think that all men reported in the story as having low-risk prostate cancer and who were treated with surgery or radiation were overtreated (half of 25,000 men), when the actual study reports 10% of men were overtreated.
Major harms of surgery or radiation are provided–incontinence and sexual problems. On the flip side, the article also points out that some cancers can be life-threatening (a risk of watchful waiting, although not explicitly stated here is that a man could miss a chance to “cure” his cancer).
The story explains that researchers collected records of men who had prostate cancer, so an astute viewer could potentially figure out that this was a cohort study (retrospective). It could be clearer.
The story describes the natural history of prostate cancer, and specifically, the fact that it is usually slow-growing and that many men may never need treatment, which is true. However, the anecdotal story, which presumably is a shining example of a watchful waiting perspective, is troublesome. This man reports being bothered by the thought of side effects and yet reports having hormone therapy, which itself has many side effects (including loss of sex drive) and it isn’t clear from the story whether this was even indicated for his cancer (so, he could be substituting one harmful treatment for another).
The story quotes an expert not related to the research to confirm that prostate cancer is often unnecessary to treat.
The story describes four treatment options–surgery, radiation, hormone therapy, and watchful waiting. However, in the example given, a man who chose not to have surgery or radiation opted for hormone therapy, which can also have significant side effects that weren’t discussed. This isn’t a good example of a “watchful waiting” strategy.
The story mentions 4 treatment options: surgery, radiation, hormonal therapy and watchful waiting. It states that many men choose either surgery or radiation, implying these treatments are widely available and it also relates an anecdotal story of one man choosing some form of watchful waiting, implying this approach is also available (although the man’s story, and specifically, the addition of hormone treatment to watchful waiting isn’t the traditional view of this approach).
The option of watchful waiting, while historically less commonly pursued than other more active treatments, is not new, which the article implies.
There’s no evidence the story relied solely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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