Division of Urology, Department of Surgery, University of Toronto, Toronto, ON.
Results from randomized trials are least prone to systematic bias and represent the highest level of evidence in medical practice. We carried out a demographic analysis examining randomized controlled trials (RCTs) in prostate cancer. Particular emphasis was placed on newly conducted phase II/III RCTs between January 1997 and March 2006.
We searched the MEDLINE database using the heading "prostate neoplasms" between January 1997 and March 2006. The results were then crossed with the MeSHs "Clinical trial.mp. OR clinical trial.pt. OR random:.mp. OR tu.xs;" this cross-checking is considered an optimal search strategy for detecting RCTs in MEDLINE® literature. The search yielded 7831 articles in total for the defined period. Of this total number, 7314 articles were manually analyzed and excluded as they did not represent RCTs. The qualifying 517 articles were then analyzed with emphasis on modality of therapy, cohort size, principal author, participating country and journal type.
Among the 517 randomized trials, most trials investigated medical therapies (42.7%). This was followed by diagnostic studies (13.2%), while the remaining categories made up 44.1%. A trend towards more completed RCTs is noted in the later years of the cohort. Cohort sizes were generally greater than 100 participants (63.1%). Urologists were the lead investigators in 48.2% of the trials. Trials were largely conducted in Europe and the United States (43.1% and 38.3%, respectively). About 7% of studies were based in Canada. Articles were generally published in surgical journals (48.4%), followed by medical journals (36.9%).
Given that initial searches yielded nearly 8000 articles listed as RCTs in prostatic oncology, only a small percentage (5.4% to 8.6%) of these were actually RCTs which reported novel results. Most of the published data were either review articles or commentaries. It is abundantly clear that new recruitment strategies need to be developed to encourage patients to enrol in RCTs and that such studies need to be undertaken in urologic oncology to provide definitive answers to the abundant and unanswered questions in urologic oncology.
Wehbi E, Hersey K, Finelli T, Fleshner NE. Are you the author?
Reference: Can Urol Assoc J. 2011 Aug;5(4):248-53.