Systematic critical appraisal of GRADE recommendations for prostate cancer staging

Abstract

Introduction. Prostate cancer staging is necessary to determine tumor extent. In recent years, new and more accurate imaging modalities that could provide a better framework for patient management have emerged. They are currently incorporated into the prostate cancer guideline recommendations. Clinical practice guidelines are an important tool for implementing clinical research findings and high-quality evidence-based recommendations.
Objective. Review and evaluate the quality of evidence underpinning the categorization of prostate cancer staging guidelines using the AGREE II tool.
Materials and methods. Systematic searches were performed on the PubMed, BiGG, and Epistemonikos databases. In addition, repositories and clinical practice guidelines websites were handsearched to identify GRADE recommendations for prostate cancer staging published in the last 5 years. Quality of clinical practice guidelines was assessed using the AGREE II tool. Recommendations and the certainty of evidence were also summarized.
Results. Seven guidelines that met the selection criteria were included. A narrative analysis of the staging recommendations and an evidence mapping were performed. The AGREE II domain “clarity of presentation” had the highest score (mean 71.59%), whereas “applicability” had the lowest score (mean 45.15%). Five guidelines met the proposed AGREE II cutoff scores and provided staging and diagnostic recommendations.
Conclusions. A significant heterogeneity was observed in the methodological quality of the included guidelines, along with common deficits, particularly in terms of applicability and stakeholder involvement. Thus, more rigorous and high-quality guidelines need to be developed to facilitate their implementation by clinicians in daily practice.