A Critical Review of Clinical Practice Guidelines for the Management of Clinically Localized Prostate Cancer

Purpose

Increasingly there is a recognized need for the development of high quality, evidenced-based clinical guidelines to assist clinicians and patients in critically important treatment related decision making. We review the different approaches used by leading urological organizations to develop guidelines for the management of clinically localized prostate cancer and their specific recommendations for case management.

Materials and Methods

Guidelines for the management of localized prostate cancer developed by leading professional organizations were identified through the National Guidelines Clearinghouse™, PubMed®, cited references and personal communication with prostate cancer experts. A structured data abstraction was applied to assess how the guideline was developed, what type of professionals and stakeholders were involved in the development process, how the primary evidence was identified and graded, and what specific final recommendations were reported.

Results

Clinical practice guidelines on the management of clinically localized prostate cancer demonstrate major differences in their specific recommendations. Few recommendations are based on high level evidence, and there are considerable discrepancies among the systems used to grade the quality of the evidence and the strength of the recommendations.

Conclusions

There appears to be a need to standardize the process used by leading urological organizations to develop clinical guidelines for the management of prostate cancer. A unified approach may offer considerable rewards in terms of efficiency, guideline credibility and optimal clinical decision making. Furthermore, increased efforts are indicated to promote studies that yield high quality evidence to guide the management of prostate cancer.

Key Words: practice guideline (publication type), prostatic neoplasms, evidence-based medicine

Abbreviations and Acronyms: AHRQ, Agency for Health Care Policy and Research, AUA, American Urological Association, BAUS, British Association of Urological Surgeons, EAU, European Urological Association, GRADE, Grading of Recommendations, Assessment, Development and Evaluation, MOH, Singapore Ministry of Health, NCCN, National Cancer Center Network, NICE, National Institute for Health and Clinical Excellence, PSA, prostate specific antigen, RCSI, Royal College of Surgeons in Ireland, RCT, randomized controlled trial