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Prostate cancer gene test: WSJ skirts around lack of long-term data

Rating

3 Star

Prostate-Cancer Gene Test Helps Patients Decide on Treatment

Our Review Summary

This Wall Street Journal story discusses available genetic tests which can theoretically distinguish between prostate cancer cases that require immediate treatment and those that need only regular monitoring for change. The latter group avoids possible surgery or radiation treatments, both of which can result in side effects that can affect a patient’s quality of life.

Much of the story focuses on anecdotes about patients and their experiences, without providing data that gives us the bigger picture about what’s known–and not known–about these tests. To its credit, the story does discuss the rather expensive costs of the tests and quotes various sources.

 

Why This Matters

The story states that, “In the U.S., there are 165,000 new cases of prostate cancer a year and about 29,000 deaths from the disease. Researchers say some men with low-risk prostate cancer, which may not require intervention, have been overtreated.” The genetic tests, the story suggests, may be effective in reducing the cases of overtreatment. But that remains to be seen, and the story didn’t emphasize that enough.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story offers clear information on the cost of the genetic tests by saying,”The various genomics tests, which have a list price between $3,800 and $5,000, generally are covered by Medicare and some private insurers.”  To its credit, it mentions the costs fairly early in the story.

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

Not Satisfactory

The presumed benefit of a test like this is the ability to avoid/delay treatment without ever being harmed from cancer progression. The story doesn’t provide data on this benefit. We’re left to wonder: How does the test compare to other tools that assess risk? Is it as useful as some of the claims being made? How accurate is it? Also, the story mentions several different companies make prostate-cancer gene tests, but the reader is left to wonder how they differ, and if accuracy varies among the products.

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

Not Satisfactory

There is always a risk of false positives or false negatives with such tests, but the story didn’t address those risks. It did do a good job discussing the harms of overtreating prostate cancer.

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

Not Satisfactory

Much of the story centers on the anecdotes about two men and their experiences having been diagnosed with prostate cancer. Their stories, while interesting and humanizing, don’t really provide any real evidence of research results. Information that actually focuses on evidence is confined to a single paragraph.

Fortunately the story did include this line:

The prostate-cancer genomics test is still fairly new, he says, and there isn’t enough data on it.

But more should have been said about that means–when there isn’t enough data? [In part, it means we need longer follow-up to determine whether men with negative genomic tests had no evidence of cancer progression as predicted by the tests–and whether these test results subsequently affected their willingness to stay on the monitoring protocols (PSA, biopsy).]

Does the story commit disease-mongering?

Satisfactory

Men diagnosed with prostate cancer often have to make difficult treatment decisions that reconcile their fears of cancer progression against their fears of treatment complications.  This story did a good job of pointing out the challenges here.

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

Satisfactory

The story uses multiple sources and in one case points out that the source was not part of the study.  In another case, the story points out that a source “has been a paid consultant for the makers of Oncotype DX and Decipher, but has no financial interest in the companies.”  One quoted source, however, is part of a company “whose aims include curbing overtreatment,” which using these tests apparently might prevent.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story did not provide any discussion of other risk assessment tools, such as the PSA test, Gleason score, biopsy results, and sometimes MRI scans.  It would be helpful to know the independent contribution of the expensive new test to decision making after adjusting for the other known risks.

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

Satisfactory

It is clear from the story that these genetic tests are currently available.

Does the story establish the true novelty of the approach?

Satisfactory

A diagnostic test that night provide an alternative to the sometimes risky treatments for prostate cancer is certainly novel enough to warrant a story.

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

Satisfactory

The story does not appear to rely on a news release.

Total Score: 6 of 10 Satisfactory

Comments (2)

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Shih, Ming-Ren

April 5, 2018 at 4:12 am

Wouldn’t your category “Does the story commit disease-mongering?” be better phrased as “Does the story avoid disease-mongering?” since your answer, “Satisfactory,” suggests that the article “Satisfactorily commits…” when really it “Satisfactorily avoids…disease-mongering.”

Reply

    Kevin Lomangino

    April 5, 2018 at 6:10 am

    Thanks for the comment. This is the first time, to my knowledge, that anyone has pointed out the potential for confusion on this point in the 12 years we’ve been reviewing news stories. But if we hear other similar complaints, we will certainly take a closer look at whether the phrasing needs to be revised.

    Kevin Lomangino
    Managing Editor

    Reply