The story describes a new study that uses PSA velocity – how rapidly a prostate specific antigen level rises – to predict which men will have aggressive prostate cancers that may benefit from earlier treatment. The article does a nice job of recognizing some of the controversy surrounding prostate cancer screening. That is, many prostate cancers are slow growing and will never threaten a man's life and it's unclear whether screening and early treatment of prostate cancer saves lives. The article also nicely includes independent sources of information, specifically a physician who cautions readers about the value of PSA velocity, to help provide balance to the story.
However, the story does not adequately describe the evidence for the findings, namely that the study is not a randomized controlled trial, so does not prove using PSA velocity can save lives. The researcher is quoted saying "This is a test that doesn't just diagnose prostate cancer. It diagnoses prostate cancer that's going to actually cause harm." But the results that are reported do not support this enthusiastic, evidence-free statement. Another limitation is not describing alternative screening options, including the decision not to be screened at all. Finally, the story does not mention that screening itself is associated with harms, such as physical pain from subsequent biopsies, anxiety, and problems related to a false positive (a false alarm) screening result. While the story does mention that many experts believe too many men are undergoing side effect prone treatments for prostate cancers which would never harm them, those treatments or side effects are not mentioned. The treatments commonly include surgery or radiation, both of which can cause problems with impotence/erections, bladder control, and bowel functioning. The side effects are not inconsequential and happen to a significant number of men (sexual problems seem to occur in a majority of treated men). The reader doesn't have any context for how serious or frequent these may be.
The story does not mention any costs of PSA testing (or the number of tests over what period of time are needed to determine PSA velocity).
The story provides survival rates for men with high PSA velocities and low PSA velocities (although the time period for the estimates is not so clear). Because this is an observational study, absolute risk reductions are not possible. While this is adequate, the story overstates what the findings mean. A quote from the lead author stating, "It doesn't just diagnose prostate cancer, it diagnoses prostate cancer that's going to actually cause harm," is unfounded and not supported by the evidence. Additionally, the story's inclusion of a recommendation from the lead author that men have "baseline" PSA tests at 40 to use as a comparison for future changes is another example of enthusiasm despite evidence.
The story does not mention that screening itself is associated with harms, such as physical pain from subsequent biopsies, anxiety, and problems related to a false positive (a false alarm) screening result. While the story does mention that many experts believe too many men are undergoing side effect prone treatments for prostate cancers which would never harm them, those treatments or side effects are not mentioned. The treatments commonly include surgery or radiation, both of which can cause problems with impotence/erections, bladder control, and bowel functioning. The side effects are not inconsequential and happen to a significant number of men (sexual problems seem to occur in a majority of treated men). The reader doesn't have any context for how serious or frequent these may be.
The story does not adequately describe the strength of the evidence for the current findings. Although the story describes that data were used from a study of aging that began storing blood samples from the 1950s, it's described in a way that many readers won't know what kind of study this was and how strong the evidence is. The story also doesn't mention that all potential confounders could not be controlled for in this study design, which could have given readers some sense of caution about interpreting the results. And, because this is not a randomized controlled trial, we still don't know whether finding these cancers early saves lives (the story mentions this, but does not state why). The researcher is quoted saying "This is a test that doesn't just diagnose prostate cancer. It diagnoses prostate cancer that's going to actually cause harm." But the results that are reported do not support this enthusiastic, evidence-free statement.
The article nicely describes the dilemma around whether or not to find and/or treat prostate cancer. Many prostate cancers are slow-growing and will never threaten a man's life. This is often lost in the enthusiasm over PSA testing. The article also provides some estimates of the number of men who will be diagnosed and die from prostate cancer this year, giving some framework for the relative burden of prostate cancer (or showing that despite a relatively larger number of men who will be diagnosed, a minority of them will die from the disease). However, the article misses an opportunity to emphasize or re-state what the numbers really mean and that they demonstrate there should be caution about widespread screening.
The article quotes the lead author, who has very encouraging things to say about using PSA velocity to screen men for prostate cancer. The author even goes so far as to encourage men have a baseline PSA test at age 40, which is not currently part of any guidelines. The article also obtains independent input from a physician who cautions readers about the value of PSA velocity, providing balance to the lead author's comments. The line "The study is far from proof that making health decisions based on the so-called PSA velocity can really save lives" also helps provide balance to the lead author's enthusiasm.
The story does not adequately talk about options, whether that's treatment options once cancer is diagnosed or alternatives to screening. For instance, the story doesn't mention the typical screening scenario (how often is it done, what does it involve?) nor does it mention the alternative of not screening, which is reasonable given that experts don't know if screening or even early treatment saves lives.
The article states this latest study could help change how PSA (or prostate specific antigen) tests are currently used, implying that PSA testing is available. The article also states that many doctors already use PSA velocity to help determine which men need biopsies, also implying that the use of PSA velocity, a particular way to use PSA testing, is available although not necessarily used by all at this time.
It's clear from the article that PSA tests and measurements of PSA velocity are not new.
Because the story quoted the lead author, an editorial writer, and an American Cancer Society official, it is unlikely the story relied solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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