Commentary: controversies in NICE guidance on prostate cancer

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 must be weighed against accompanying harms and costs. Few studies enrolled men with disease that had been detected as a result of measuring the level of prostate specific antigen (PSA) or were adequately powered to assess survival outcomes. Individual patients and providers may place different values on a particular outcome or have clinical and tumour characteristics that have not been adequately assessed by the trials providing the evidence used for drafting …