This was too simplistic and drew unsatisfactory grades on 8 out of 9 applicable criteria. Read details below.
This particular week is a busy week in prostate cancer news: a JAMA paper on IMRT vs. proton beam therapy and Fox News promoting robotic surgery over the Cyberknife…and then this story. Readers need clear, contextual, evidence-based analysis to help them sort through all of the claims swirling around them.
The story quoted another news source quoting the researcher, who claimed “that HIFU may also be cheaper than other standard treatments, noting that the cost of the MRI and mapping was an estimated $2,400, plus about $1,600 for HIFU; in comparison, removing the prostate costs about $7,100. Fewer side effects would also lower other health care costs, he said.”
But that quote from the researcher may have been an incomplete assessment of costs.
It’s unknown if cancers are more likely to recur following HIFU. If they were, then ultimate costs would be higher. In fact, the Lancet article noted that 4 men required retreatment within one year. Additionally, 39 of 41 men had repeat MRI/biopsy after 6 months. While that may have been just part of the research protocol, the extent to which repeat MRI/biopsy are part of clinical practice would also contribute to costs.
We’re told that “Overall, about 95% of the men were cancer-free after a full year following the trial.” But, again, that may have been an incomplete picture.
The Lancet article indicates that this includes 4 men who required retreatment. “Cancer-free” is based on MRI results. Most men were also biopsied after 6 months to determine whether there was microscopic evidence of cancer and 9 of 39 did have evidence.
The story stated that “None of the patients reported urinary incontinence a year after treatment, and only 1 in 10 suffered from poor erections.” Again, this was not the whole story. 17% of men developed urinary tract infections after the procedure and men required catheters for an average of 8 days.
The story states that:
While the initial results were promising, they need to be replicated; HIFU also needs to be studied long-term and compared with other therapies. If the technology holds up, it could also work for other cell-based cancers like breast, thyroid, pancreas and liver, Ahmed said.
But, given that this was a proof of concept study in just 41 men, the emphasis should have been greater that this was very preliminary data. It was also an uncontrolled trial (no control group for comparison), yet the story allowed the researcher to get away with making claims about a better chance of “the perfect outcome” from this approach.
Then, letting him get away with this comment at this early stage was a bit over the top: “If the technology holds up, it could also work for other cell-based cancers like breast, thyroid, pancreas and liver.”
The Lancet article appropriately noted that one-year followup is far too short to fully evaluate cancer outcomes.
No disease mongering.
No independent sources were quoted – only the lead researcher.
As noted in the “Evidence” criterion above, we feel the story allowed the researcher to get away with making comparative claims of superiority after a very preliminary study in just 41 men.
Among the other therapies to be mentioned would be active surveillance (deferring any active treatment until/unless there is evidence of cancer progression), which is an appropriate strategy for men with low-risk cancers (27% of the study group according to the Lancet article).
The story was about a British study. There was no mention of the availability of HIFU in the US.
The story made no reference to any past research on HIFU for prostate cancer. This isn’t the first research in this area – yet the story may suggest that to readers.
The story appears to be based on someone else’s story – Bloomberg’s.
The intent of this criterion is to promote independent vetting of claims.
We’re not sure that happened any more with this approach than it would with copying from a news release.
We’ll rule it Not Applicable because we certainly can’t give this a Satisfactory score.