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WSJ story on prostate procedure: No independent sources were quoted

Rating

3 Star

New Procedure Looks Promising for Men With Enlarged Prostates

Our Review Summary

enlarged prostateThe story focuses on a relatively new treatment for patients with enlarged prostates who have related urinary problems, such as the need to urinate frequently. The treatment has been clinically available since late 2016, and the story also refers to a study published online in the Journal of Urology in December 2016. The treatment is called “Rezūm,” and involves using targeted blasts of steam to shrink prostate tissue.

The story does a fair job of describing the technique and its costs, but would have been much stronger if it had incorporated input from an expert or experts who have no ties to the company that markets the treatment.

 

Why This Matters

Because there is no independent source, it raises the possibility that the story is presenting the rosiest possible take on this technology and its effects.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story does a good job here, noting that a treatment with Rezūm costs around $2,000, and that it is often (but not always) covered by health insurance. In addition, the story notes that patients may need multiple treatments.

As a side note, we would like to know how this compares with costs of surgery and with costs of other minimally invasive procedures.

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

Not Satisfactory

The story notes that “At the end of two years, patients treated with Rezūm showed a 51% reduction in urinary symptoms (as measured by a seven-question survey), compared with the beginning of the study.”

However, without knowing what a sample baseline was, it’s hard to say if this is a big improvement. (51% of what?)

We also wanted to know more about the patients: Average age, average prostate size, whether subjects had tried medications, whether investigators assessed improvement in not just self-reported symptoms but also urinary stream.

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

Satisfactory

The story discusses a few potential side effects, at least to the same extent as discussed in the related journal article — namely, the need to wear a catheter for a few days after treatment, and issues in some patients related to ejaculatory volume. It also talked about the need for more long-term data.

That said, it would have been helpful to specifically address other potential treatment side effects–bleeding, infection, etc.

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

Satisfactory

The story makes clear that this was a controlled study, with some patients receiving a placebo (or “sham procedure,” in the words of the story). It also makes clear that the study was of 197 men. The story also notes that the research was done on men with enlarged prostates, but not “large” ones — meaning there is still no clinical data on the extent to which Rezūm may work for patients whose prostates are larger than 80 grams.

One point that is a little confusing refers to how Rezūm works. Early in the story, the procedure is described this way: “Thermal energy in the form of steam is applied to the prostate with a needle. As it cools it releases heat energy into the tissue, killing cells and shrinking the prostate overall by about a third.” Later in the story, a NxThera employee says “Early in the trial, physicians were new at performing the procedure and didn’t always remove enough tissue.” It’s not clear what this means. Are the dead prostate cells removed in some way during treatment? Or are the absorbed back into the body? Were physicians not applying enough steam, or were they failing to remove dead cells in some other part of the procedure?

One detail that would have improved the story: Until comparison trials are completed, we don’t know how this treatment compares to surgery or other medication.

Does the story commit disease-mongering?

Satisfactory

We are always on the lookout for disease mongering in stories like this one, in which a medical condition that affects quality of life could misleadingly be treated as if it was a life-threatening illness. This story handles the issue well, treating an enlarged prostate and its related symptoms in a matter-of-fact way — neither downplaying nor sensationalizing the symptoms associated with an enlarged prostate.

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

Not Satisfactory

There are no independent sources here. Claus G. Roehrborn, who is referred to as a co-author on studies of enlarged prostate treatments, is a paid consultant to the study’s funder, NxThera (see this 2015 paper), but the story didn’t disclose that. As noted above, input from an independent source would have made this story much stronger.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There are numerous other minimally invasive treatments (laser, thermotherapy, radio frequency ablation) that are not mentioned.

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

Satisfactory

It is clear that Rezūm is clinically available.

Does the story establish the true novelty of the approach?

Not Satisfactory

It isn’t clear what makes this treatment novel, nor why the story is running now. Rezūm has been on the market for since last year, and the related research was published more than four months ago. Maybe it’s because two major health insurance companies decided earlier this month to cover the treatment?

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

Satisfactory

The story does not appear to be based on a news release.

Total Score: 6 of 10 Satisfactory

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