Commentary: controversies in NICE guidance on prostate cancer

doi:10.1136/bmj.39501.621690.AD

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

Practice

Commentary: controversies in NICE guidance on prostate cancer

Timothy J Wilt, professor of medicine¹

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

Tim.wilt@med.va.gov

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 comprehensiveadvice on best practice for diagnosis and treatment of prostatecancer. They are based on systematic reviews of the evidence,incorporate multidisciplinary opinions, and try to balance thevalues of healthcare providers and patients for various outcomeswhile emphasising a patient centred approach. Their conclusionsare generally consistent with other reviews and guidelines evaluatingsimilar evidence.¹ ² ³ ⁴ ⁵ If followed, these recommendationswill likely improve prostate cancer outcomes while reducingunnecessary, 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 bythe lack of high quality information available. The paucityof randomised trials limits the quality of data used for informeddecision making, particularly regarding detection and treatmentof localised disease. Even where randomised trials have shownbenefits, 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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Diagnosis and treatment of prostate cancer: summary of NICE guidance: John Graham, Mark Baker, Fergus Macbeth, Victoria Titshall on behalf of the Guideline Development Group
BMJ 2008 336: 610-612. [Extract] [Full Text] [PDF]