Systematic critical appraisal of GRADE recommendations for prostate cancer staging

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 important for implementing clinical research findings and high-quality evidence-based recommendations.

Objective: To review and evaluate the quality of evidence underpinning the categorization of prostate cancer staging guidelines using the AGREE II tool.

Material and methods: Systematic searches were performed on the PubMed, BiGG, and Epistemonikos databases. In addition, repositories and clinical practice guidelines websites were hand searched to identify GRADE recommendations for prostate cancer staging published in the last five years. The 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 evidence mapping was 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: Significant heterogeneity was observed in the methodological quality of the guidelines included, along with common deficits regarding applicability and stakeholder involvement. Thus, more rigorous and high-quality guidelines need to be developed to facilitate their implementation by clinicians in daily practice.