Guidelines

Prostate Cancer

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2. Methods

2. METHODS

2.1. Data identification

For the 2023 PCa Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A number of comprehensive searches were performd, covering all sections of the PCa Guidelines. The search was limited to English language publications. Databases searched included Medline, EMBASE and the Cochrane Libraries, covering a time frame between May 1st 2021 and April 1st 2022. A total of 2,480 unique records were identified, retrieved and screened for relevance resulting in 166 new publications having been included in the 2023 print. A detailed search strategy is available online:
https://uroweb.org/guideline/prostate-cancer/?type=appendices-publications.

Changes in recommendations were generally only considered on the basis of high-level evidence (i.e. systematic reviews with meta-analysis, randomised controlled trials [RCTs], and prospective comparative studies) published in the English language. Additional information can be found in the general Methodology section of this print and online at the EAU website: https://uroweb.org/guidelines/policies-and-methodological-documents/.

For each recommendation within the guidelines there is an accompanying online strength rating form which includes the assessment of the benefit to harms ratio and patients’ preferences for each recommendation. The strength rating forms draw on the guiding principles of the GRADE methodology but do not purport to be GRADE [3,4]. These forms address a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [5];
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’ [6]. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences. The strength rating forms will be available online.

A list of Associations endorsing the EAU Guidelines can also be viewed online at the above address. In addition, the International Society of Geriatric Oncology (SIOG), the European Society for Radiotherapy & Oncology (ESTRO), the European Society for Urogenital Radiology (ESUR), the European Association of Nuclear Medicine (EANM) and the International Society of Urological Pathology (ISUP) have endorsed the PCa Guidelines.

2.2. Review

Publications ensuing from systematic reviews have all been peer-reviewed.

2.3. Future goals

Results of ongoing and new systematic reviews will be included in the 2024 update of the PCa Guidelines:

  • A systematic review assessing the performance of risk stratification tools incorporating imaging, biomarkers, biopsy involvement and/or MRI-targeted biopsies, compared to the classical risk classifications (d’Amico, EAU, CAPRA and NCCN) recommended in current guidelines for predicting biochemical recurrence, metastasis or death after local treatment for prostate cancer. Are the new stratification tools preferred above the classical risk classifications?
  • A systematic review assessing the outcomes of brachytherapy boost combined with external beam RT for PCa.
  • Care pathways for the various stages of PCa management are being developed. These pathways will, in due time, inform treatment flowcharts and an interactive app.
  • Assessment of individual patient life expectancy – development of a calculator.