Dahm Philipp, Yeung Lawrence L, Chang Sam S, Cookson Michael S
Department of Urology, University of Florida, College of Medicine, Gainesville, Florida, USA.
J Urol. 2008 Aug;180(2):451-9; discussion 460. doi: 10.1016/j.juro.2008.04.004. Epub 2008 Jun 11.
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.
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.
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.
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.
人们越来越认识到需要制定高质量、循证临床指南，以协助临床医生和患者做出极其重要的治疗相关决策。我们回顾了主要泌尿外科组织用于制定临床局限性前列腺癌管理指南的不同方法及其病例管理的具体建议。
通过国家指南交换中心、PubMed、参考文献引用以及与前列腺癌专家的个人交流，确定主要专业组织制定的局限性前列腺癌管理指南。应用结构化数据提取来评估指南的制定方式、参与制定过程的专业人员和利益相关者类型、主要证据的识别和分级方式以及报告的具体最终建议。
临床局限性前列腺癌管理的临床实践指南在其具体建议上存在重大差异。很少有建议基于高级别证据，并且在用于评估证据质量和建议强度的系统之间存在相当大的差异。
似乎有必要规范主要泌尿外科组织制定前列腺癌管理临床指南的过程。统一的方法可能在效率、指南可信度和最佳临床决策方面带来可观的回报。此外，需要加大力度促进产生高质量证据以指导前列腺癌管理的研究。
