Making sense of media reporting on prostate cancer

Making sense of media reporting on prostate cancer 

We live in an information-rich time; never before has so much content been available to each of us so quickly and easily. Our  challenge is to differentiate quantity and quality amongst the deluge. Online searches are increasingly spent navigating through misinformation and fake news and distinguishing “my truth” from the truth in the information we retrieve. Even “quality” mainstream media leaves us sceptical about reporting that prompts more questions than provides answers. 

Information about our health can be particularly overwhelming and challenging to understand. We typically apply different filters when engaging with health content, as our interest is  often related to ourselves or loved ones. Emotion plays a big part in how we process stories, research and advice about our health. After all, we are only human – the AIs haven’t displaced us yet.

The picture above is an extreme version of health misinformation – but it did grab your attention, didn’t it? Fortunately our filters kick into gear with headlines like this one. And often they relax when presented with less contentious headlines in more “respectable” media outlets, especially when these reference scientific and clinical studies to advance a narrative. How do we engage with these stories so that we are genuinely informed, and ideally with a roadmap to learn more?

Two recent stories about prostate cancer appeared in the Daily Mail, which provide useful examples of how and what to interrogate from the information reported. One is about PSA testing, and the other about Active Surveillance.

The first story reported that “A blood test on request for prostate cancer should be scrapped because it is harming men, according to experts” and went on to argue that .

“experts want this approach to be scrapped, as allowing men to request a PSA test risks them having unnecessary treatment such as prostate surgery, which can lead to lifelong incontinence and erectile dysfunction.”

The article states that this is because 

“men are being diagnosed with slow-growing cancers they probably don’t need to know about after an unnecessary PSA test …up to half of men diagnosed with prostate cancer from a PSA test would never have noticed it otherwise … but the diagnosis puts them on a medical pathway, starting with an uncomfortable biopsy and potentially leading to drugs which cause fatigue and loss of libido.”

The second story reported that 

“evidence suggests patients with tiny (prostate) tumours don’t usually need to start treatment. Instead they can simply be monitored with regular blood tests and scans to ensure the tumours don’t start to spread … with the aim of sparing them from complications following invasive surgery and radiotherapy, which can include incontinence and erectile dysfunction”. 

It referenced “a major study published last month which proved that survival rates for those who are monitored are the same as for those given more aggressive traditional treatment.”

The study referenced in this piece – but not named or linked — is the Protect trial.

Neither of these stories are misinforming per se or providing false information, but they make a case without what we consider to be complete information. The pictures presented are incomplete and could lead anyone affected by prostate cancer to make suboptimal decisions about their own health and care.

Both stories ignored significant clinical and practice developments in the diagnostic pathway for prostate cancer based on imaging – so in the first story, suggesting that PSA testing leads to harm neglects to mention that guidance on the diagnostic pathway following an elevated PSA is to have an MRI scan. This effectively reduces harm through unneccesary biopsies and potential invasive treatment.

The reality is a PSA test is all we have to trigger an MRI but this mitigates any harm, often ruling out further diagnostic procedures such biopsies, and underpinning less invasive treatment like focal therapy.

In the second story, the importance of imaging is reported but the realities of how imaging of the prostate is practiced and what this means for men on Active Surveillance is not. 

As TFTC Consultant Urologist Marc Laniado said in a recent interview, about the Protect trial and its interpretation for those newly diagnosed with prostate cancer

“Guidance on … the quality of the MRI scans and how sure you can be that they’re reliable isn’t there. It is in journals, but it’s not broadly distributed and it doesn’t seem that there is widespread checking of the protocols, scanners, the people reporting and the quality of the reporting. It’s just not done really in this country, not at the moment anyway”.

He also pointed out that the study was conducted over a 15-year period when focal therapy was not practiced widely but now that the evidence base is strong and continues to build, focal therapy is a real option for men in addition to Active Surveillance and surgery and radiotherapy which the study focused on.

And it’s also important to note from the study that of the men who underwent Active Surveillance for their prostate cancer, 75% went on to have radical treatment within five years.

Media outlets would do a great service in pursuing stories about prostate imaging and the variability in availability and quality that Marc Laniado refers to. This has real impact on the potential harm of a PSA test and the effectiveness of Active Surveillance. Tip of the day, Daily Mail.