Today's internet media culture allows information - both accurate and misleading - to spread rapidly and widely. Thus, it can be challenging for patients to sift through the information and determine what is factual - and what is not - about prostate cancer.
For example, a recent study led by Dr. Stacy Loeb, M.D. MSc and other investigators at New York University looked for misleading or biased medical information in YouTube videos on prostate cancer. There are more than 600,000 videos on prostate cancer on YouTube.
The study examined the 150 mostviewed videos on the disease and found that 77% had factual errors or biased content, either in the video or the comments section. Yet, the reach of these videos is broad. The average number of people viewing the videos was 45,000, but some had as high as 1.3 million viewers.
Just 75% of the videos fully described the benefits of various treatments, and just over half sufficiently covered potential harms and side events. In addition, 19% of the videos recommended alternative or complementary therapies that are not proven to be safe or effective. One example of this is a video that promoted "injecting herbs" into the prostate gland to treat cancer, a method that is not backed by medical evidence.
Dr. Loeb also said that only 50% of the videos described "shared-decision making," which is generally recommended as the current standard of care in prostate cancer screening and treatment. Dr. Loeb said that care providers should direct their patients to credible sources of medical information.
The study was published online in European Urology in November.
Evidence-based information on PSA testing
There are numerous examples of misleading advice regarding PSA testing in the media. When looking for medical advice, the key is to find information that is evidence-based, to check your sources, and to confer with your physician.
Long-term data strongly indicates that with early detection, men have a greater chance of finding and treating prostate cancer before it spreads. During the PSA screening era (1991-2008), there was an 80% decrease in the percentage of men who had advanced prostate cancer at the time of diagnosis, and a 53% decrease in the prostate cancer death rate.
Conflicting guidelines and recommendations on prostate cancer screening have further created confusion. In 2009 and 2011, the U.S. Preventive Services Task Force (USPSTF) released national recommendations against the use of PSA testing. The recommendation was widely discussed in the news.
However, the USPSTF guidelines panel weighed heavily on flawed data in the PLCO trial, which inaccurately reported no decrease in mortality from PSA testing. Other randomized trials have systematically followed large groups of men who were assigned to a screening group and underwent routine PSA testing, or to an unscreened arm. For example, the Goteberg trial in Europe found a 44% decrease in prostate cancer death rates in men who underwent systematic PSA screening.
A year ago, the USPSTF updated is recommendation. Now, they recommend shared-decision making for men ages 55-69 years, taking into account a man's preference, life expectancy, and overall health when making decisions regarding PSA testing.