BMJ  2008;336:612-614 (15 March), doi:10.1136/bmj.39501.621690.AD

Practice

Commentary: controversies in NICE guidance on prostate cancer

¹ Minneapolis VA Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417

doi: 10.1136/bmj.39498.525706.AD

The first 150 words of the full text of this article appear below.

The NICE guidelines on prostate cancer provide comprehensive advice on best practice for diagnosis and treatment of prostate cancer. They are based on systematic reviews of the evidence, incorporate multidisciplinary opinions, and try to balance the values of healthcare providers and patients for various outcomes while emphasising a patient centred approach. Their conclusions are generally consistent with other reviews and guidelines evaluating similar evidence.^{1 2 3 4 5} If followed, these recommendations will likely improve prostate cancer outcomes while reducing unnecessary, ineffective, harmful, and costly care.

Paucity of randomised controlled trials

Although NICE’s recommendations are generally appropriate, any guidelines on prostate cancer are going to be hampered by the lack of high quality information available. The paucity of randomised trials limits the quality of data used for informed decision making, particularly regarding detection and treatment of localised disease. Even where randomised trials have shown benefits, the absolute magnitude of benefit is generally small, requires many years to accrue, and . . . [Full text of this article]

Limitations that may reduce uptake by clinicians

Basing treatment recommendations on patient and tumour characteristics

The role of PSA testing in deciding when to perform biopsy

Emerging technologies

Does the structure and process of health services affect patient outcomes?

Dissemination and implementation

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