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.
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.
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.
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.
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.
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).]
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.
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.
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.
It is clear from the story that these genetic tests are currently available.
A diagnostic test that night provide an alternative to the sometimes risky treatments for prostate cancer is certainly novel enough to warrant a story.
The story does not appear to rely on a news release.