Prostate Cancer Screening and the Role of Clinical Practice Guidelines

ABSTRACT Background: In recent years, clinical practice guidelines (CPGs) have become more heavily relied upon by clinicians to navigate the expansive, ever-changing scientific literature. With no central guideline-issuing body, guidelines are issued by a variety of medical organizations and governmental agencies; with no mandatory standards for guideline development process, these guidelines are not all of the same quality. The contentious prostate cancer screening debate provides a useful backdrop to examine the development process and role of clinical practice guidelines. Methods: To assess the guideline development processes of the five “major” guideline-publishing bodies on prostate cancer screening (ACP, ACPM, ACS, AUA, and USPSTF), pre-defined variables were used to evaluate important characteristics of publishing bodies, CPG development committees, evidence review processes, clinical recommendations, and conflicts of interest. These variables were chosen to reflect Institute of Medicine standards as well as to highlight important steps in the recommendation development process. Findings: All five recommendation statements fell considerably short of IOM standards, particularly in regards to committee selection, guideline crafting and addressing conflicts of interest. The CPG-issuing groups published a variety of recommendations statements ranging from insufficient evidence to recommend prostate cancer screening to recommending against screening in all men. Conclusion: IOM standards as a whole have yet to gain traction with CPG-issuing groups, although some changes have been made since they were issued in 2011. In a medicine culture where CPGs are often treated as standards of care, it is important that clinicians carefully and critically review recommendation statements, including the process by which they were developed.Master of Public Healt