I never cease to be amazed at the amount of publication that comes from various individuals and teams at the University College London. On top of their clinical work with patients, and conducting clinical trials, I am impressed with their commitment and energy level when it comes to setting fingers to keyboard and writing articles worthy of publication in peer-reviewed journals.
An article published by four of their staff (August, 2014) is titled “Defining the Level of Evidence for Technology Adoption in the Localized Prostate Cancer Pathway.”[i] It is aimed at academic researchers who are rapidly exploring new diagnostic and treatment approaches in hopes of improving patient outcomes, especially quality of life issues. Still, there is debate among prostate cancer experts as to whether there is sufficient high level research into multiparametric MRI, MRI-guided biopsies, and focal ablation to justify how quickly university medical centers seem to be offering them.
The authors call for the highest possible level of scientific evidence to demonstrate the value of each of these technologies, noting that academic centers that now offer them also have the capability of conducting studies into their effectiveness. The merits of scientific evidence are based in this hierarchy:
Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT’s), or evidence-based clinical practice guidelines based on systematic reviews of RCT’s
Level II: Evidence obtained from at least one well-designed Randomized Controlled Trial (RCT)
Level III: Evidence obtained from well-designed controlled trials without randomization, quasi-experimental
Level IV: Evidence from well-designed case-control and cohort studies
Level V: Evidence from systematic reviews of descriptive and qualitative studies
Level VI: Evidence from a single descriptive or qualitative study
Level VII: Evidence from the opinion of authorities and/or reports of expert committees
In the surgical sciences, obtaining Level I evidence is thorny. Problems such as randomly assigning patients to a novel vs. a conventional treatment, investigator bias, poorly designed or implemented protocols, etc. are obstacles. Therefore, the authors describe ways that academic research into novel prostate cancer technologies can be conducted to satisfy the demand for good scientific evidence. Their wisdom is too detailed to sum up in a blog, but the whole article is available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136740/.
I’m giving fair warning, being an academic article, it’s a lot to digest—and you may want to use Wikipedia if you’re not familiar with some of the terminology. That said, though the Sperling Prostate Center is not academic, we constantly strive to uphold standards of consistency and record-keeping as we work with patients throughout the detection, diagnosis, treatment and follow up process. Even community medical centers such as ours must contribute to scientific evidence as much as we can.
[i] Valerio M, El-Shater Bosaily A, Emberton M, Ahmed HU. Defining the level of evidence for technology adoption in the localized prostate cancer pathway. Urol Oncol. 2014 Aug;32(6):924-930.