Few prostate cancer guidelines are of high methodologic quality and therefore trustworthy

Prostate cancer is the most common malignancy among men worldwide, underscoring the importance of high-quality, evidence-based clinical practice guidelines (CPGs) in this field. We conducted this study to evaluate the methodologic quality of prostate cancer CPGs.

Following a prespecified protocol, we conducted a cross-sectional study of English-language prostate cancer CPGs published between 2014 and 2024, searching Medline (Ovid), Trip, EMBASE, ECRI, Guidelines International Network, and Guidelines Central databases. We included guidelines covering screening, diagnosis, and/or management of prostate cancer. Two reviewers independently applied the modified National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) instrument, consisting of 10 items and generating summary scores from 10 (lowest) to 50 (highest) points. Guidelines were categorized as low-(≤16), intermediate- (17-31), or high-quality (≥32).

Of 1005 references screened, 23 international guidelines met the inclusion criteria. Only six CPGs (26%) were rated high-quality; over one-third (8/23, 34.7%) were categorized as low-quality. Most CPGs inadequately reported conflicts of interest, multidisciplinary panel composition, or systematic review methods underpinning recommendations. No significant associations were observed between guideline quality and year of publication or breadth of scope.

Most prostate cancer CPGs published in English demonstrate limited methodologic rigor, not meeting National Academy of Medicine standards for trustworthy guidelines. Guideline users should critically appraise these documents prior to implementation, and developers are encouraged to adopt established frameworks, such as GRADE, to improve quality.