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Deciphering the Results of a Prostate Test


2 Star

Deciphering the Results of a Prostate Test

Our Review Summary

This article describes the history and some of the current dilemmas of PSA screening for prostate cancer. Although it does a nice job of discussing some of the current controversies in PSA testing for prostate cancer, it does not discuss the real controversy of PSA testing, that is, there is no convincing evidence that PSA testing saves lives.  The story also introduces some inaccuracies around PSA testing.  These include stating that the decline in prostate cancer death rates is due to PSA testing (we don't know this for sure), that "guidelines" recommend all men have annual PSA testing beginning at age 50 (most guidelines do not say this and instead encourage individualized decision making), and that PSA velocity used in screening is a better indicator of cancer than a one-time measurement (we don't yet know the precise usefulness of PSA velocity in screening).  Other notable areas that are missing include the option of not screening at all and a discussion of treatment options, including their potential harms. 


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No costs are mentioned. 

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

Not Satisfactory

The article doesn't provide any evidence of the potential benefits of PSA screening. 

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

Not Satisfactory

Specific harms of screening and its downstream consequences are not mentioned.  For instance, the article only states prostate cancer surgery is debilitating, without stating why or how and without recognizing that other prostate cancer treatments, like radiation, can also have debilitating side effects, like problems with erections, leaking urine, and problems with bowel function (which is not stated).  The article doesn't tell readers how severe these problems could be or how frequently they might occur.  There is also harm in managing the many false positive test results that occur, which is not mentioned; the biopsies can be painful, are often not definitive because they are random, and there are psychological consequences, like anxiety, that men endure. 

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

Not Satisfactory

The sources of the data cited are not given, and there is no mention of the strength of any of the data quoted from studies.  Readers don't know whether information is based on trial data or something else that is less robust.  For instance, the article claims a new study by one of the sources shows that using PSA velocity is a better indicator than one PSA test.  However, readers don't know what type of study this is based on and that more studies are needed to know this for sure.  The article also states the PSA test is controversial but does not even mention the crux of the controversy, which is the absence of convincing evidence that prostate cancer screening saves lives.  The article makes this sound as if the controversy is only about fluctuations in PSA readings.  What's more, it's not even clear that aggressive treatment of early detected cancers is effective, none of which is mentioned. 

Does the story commit disease-mongering?

Not Satisfactory

There are several inaccuracies in the description of prostate cancer and prostate cancer screening.  One, the story quotes a source who attributes the drop in prostate cancer deaths to PSA screening, which is not known for sure (and there were advances in medical treatment at the same time even though this source states there weren't).  There could be other reasons for the drop in prostate cancer deaths.  Another inaccuracy is that the story states "guidelines" (without explaining which guidelines) recommend all men have an annual PSA test beginning at age 50.  This is not true; in fact, major guideline-issuing organizations like the American Urological Association, the American Cancer Society, and the U.S. Preventive Services Task Force recommend a shared decision making approach which individualizes this choice based on personal preferences and values.  Third, the idea of using PSA velocity in prostate cancer screening has not been well-studied and there is not a lot of evidence to prove the value of this approach.  The article states using PSA velocity is a better approach than using a single test for prostate cancer screening, which has not yet been proven (although this approach is often used in monitoring advanced disease after diagnosis).  Although a minor inaccuracy, the article also quotes a source who states that PSA does not fluctuate based on sexual activity.  However, the evidence for this is mixed and not conclusive. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The article does not describe the option of no screening, nor does it describe all treatment options if prostate cancer is diagnosed, such as watchful waiting or radiation (in addition to surgery that it does breifly mention). 

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


The article states that most men over 40 know that the PSA test is widely used for prostate cancer screening. 

Does the story establish the true novelty of the approach?


The article describes the time PSA testing began to be used – in the early 1990's.  It also talks about several variations of PSA testing (PSA velocity, free-PSA, complexed PSA), which are relatively new. 

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


Because the article cites several sources, it is unlikely that it relied solely or largely on a news release.

Total Score: 4 of 10 Satisfactory


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