title: Clinical practice guidelines on prostate cancer: a critical appraisal.
abstract: OBJECTIVE
  Clinical practice guidelines are increasingly being used by leading organizations to promote high quality evidence-based patient care. However, the methodological quality of clinical practice guidelines developed by different organizations varies considerably. We assessed published clinical practice guidelines on the treatment of localized prostate cancer to evaluate the rigor, applicability and transparency of their recommendations.
  
  
  METHODS
  We searched for English based clinical practice guidelines on treatment of localized prostate cancer from leading organizations in the 15-year period from 1999 to 2014. Clinical practice guidelines limited to early detection, screening, staging and/or diagnosis of prostate cancer were excluded from analysis. Four independent reviewers used the validated AGREE II instrument to assess the quality of clinical practice guidelines in 6 domains, including 1) scope and purpose, 2) stakeholder involvement, 3) rigor of development, 4) clarity of presentation, 5) applicability and 6) editorial independence.
  
  
  RESULTS
  A total of 13 clinical practice guidelines met inclusion criteria. Overall the highest median scores were in the AGREE II domains of clarity of presentation, editorial independence, and scope and purpose. The lowest median score was for applicability (28.1%). Although the median score of editorial independence was high (85.4%), variability was also substantial (IQR 12.5-100). NICE and AUA clinical practice guidelines consistently scored well in most domains.
  
  
  CONCLUSIONS
  Clinical practice guidelines from different organizations on treatment of localized prostate cancer are of variable quality and fall short of current standards in certain areas, especially in applicability and stakeholder involvement. Improvements in these key domains can enhance the impact and implementation of clinical practice guidelines.
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: Mohit
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: John
authors.initials: J
authors.lastname: McCauley
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: Amy
authors.initials: A
authors.lastname: Farkas
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gudeloglu
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida; Urology Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Neuberger
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Yen-Yi
authors.initials: YY
authors.lastname: Ho
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Yeung
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida.
authors.forename: Johannes
authors.initials: J
authors.lastname: Vieweg
authors.affiliation: Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida; Department of Urology, University of Minnesota, Minneapolis, Minnesota; Urology Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota. Electronic address: pdahm@umn.edu.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
mesh_terms: D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000628:therapy*
keywords: Florida; evidence-based medicine; government; practice guidelines as topic; prostatic neoplasms