Understanding the Prostate Literature: The Need for a Multi-Disciplined Approach

Author: Rodger J. Winn MD
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Oncologists take great pride in basing practice on the evidence that comes from well-designed trials. Critical appraisal of clinical data requires a firm grounding in the precepts of sound investigational methodology and a basic understanding of the underlying statistical analyses that lead to the conclusions drawn from a study. This knowledge base is further refined at professional meetings that facilitate critical commentaries. Clinical practice guidelines with texts that explain why a particular study did or did not change practice recommendations are another valuable means of developing analytic skills.This issue works to further sharpen these analytic skills, for example with the assessment from Rosenbaum et al. of the complex data surrounding the management of a post-therapeutic rising PSA and Ryan and Small's discussion of the multiple issues surrounding the use of hormonal therapy, including monotherapy or combined blockade, continuous or intermittent schedules, and the timing and duration of therapy.Moving on to some of the other articles, additional analytic skills are also necessary:– A solid understanding of the tools of clinical epidemiology are called into play in the article by Naya and Okihara on complexed PSA. Although the average oncologist may be comfortable with the definitions of sensitivity and specificity, the full implications of the positive predictive value of a test may be less clear, and the significance of a receiver operator curve (ROC) may be even more nebulous.– The Prostate Guideline is one of the first NCCN pathways to use a predictive nomogram1 in determining algorithm pathways...

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