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Prostate test could be more accurate

Rating

4 Star

Prostate test could be more accurate

Our Review Summary

The article describes a potential new test for prostate cancer – still in the early stages of laboratory testing – that may more accurately identify those with cancer from those without cancer.  However, while a more accurate test may tell who has prostate cancer better, it still does not tell which men need treatment in their lifetime and which men don't, which is the real problem in prostate cancer screening.  The article does try to discuss this controversy, but unfortunately attributes a decline in death rates to prostate cancer screening, which is not known for certain because advances in prostate cancer treatment also occurred around the same time.  This presents an overly optimistic view of what prostate cancer screening can do.  Other areas which were not addressed appropriately included: what type of evidence the findings are based on and a more complete discussion of the serioiusness and frequency of potential harms.

Overall, though, the story addressed most of our criteria in a story of less than 1,000 words. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention costs.  Any cost of a screening test must take into account downstream costs, such as follow-up testing and confirmatory testing. 

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

Satisfactory

The article provides the number of true positives (the number of men who were identified by the test as having cancer and actually did have cancer) and false positives.  However, we don't know enough about the study to put the quoted false positive and negatives in perspective.  The test might perform more poorly in the real-world.  Although the new study wasn't a study of outcomes, it would be most meaningful to know whether this new screening has any impact on the chance of death from prostate cancer.  But, those answers aren't likely to come anytime soon. 

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

Satisfactory

The story describes harms of prostate cancer screening, such as need for biopsy and/or treatment, both of which have side effects (which are described).  However, the story does not tell readers how serious these might be or how often these harms might occur. Nonethless, we'll give the story the benefit of the doubt on this criterion.

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

Not Satisfactory

The story does not describe what type of study was used to evaluate the new prostate cancer test.  An exploratory study of a diagnostic test on patients with known disease or lack thereof is very different from a field-test where a test is validated on undifferentiated patients.  We don't know what type this one is.  We do know that this is not a randomized trial of testing versus an alternative, and this robust study design would be necessary to know whether the proposed test actually leads to better health, let alone longer life.

Does the story commit disease-mongering?

Not Satisfactory

The story does try to let readers know there is controversy over prostate cancer screening and even with a newer prostate cancer test, men could still be treated for something that wouldn't have caused harm in their lifetimes.  However, the story attributes a decline in the prostate cancer death rate to PSA screening, which is not known for certain since many advancements in treatment occurred around the same time.  This paints an overly optimistic view of screening.  The article also repeatedly describes the goal of minimizing biopsies when no cancer is detected, as though a biopsy is appropriate whenever cancer is detected.  Prostate cancer can be a slowly progressive condition that can be clinically irrelevant, so to find it on a biopsy may or may not be important. The article eventually cites a balanced critic who worries that men may be 'overdiagnosed.' "

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Several sources of information are quoted, including at least one who questions the value of the latest prostate cancer test. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story very briefly mentions treatment options once cancer is found, namely surgery, radiation, or active surveillance (watchful waiting).  However, the article could have mentioned the alternative strategy of not testing at all for prostate cancer or the fact that digital rectal exam is the strategy that leads to the fewest unnecessary biopsies. 

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

Satisfactory

The article states the new prostate cancer test is still being tested for effectiveness and also provides a timeline of when the new test might be submitted for government approval, letting readers know this test is not currently available. 

Does the story establish the true novelty of the approach?

Satisfactory

It's clear from the article that this is a new approach to prostate cancer screening. 

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

Satisfactory

Because the story included input from two other sources besides the principal investigator, it is safe to assume it did not rely solely or largely on a news release. 

Total Score: 7 of 10 Satisfactory

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