Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.
Population: Men (age range 45-76 years) who have undergone radical prostatectomy
Intervention: Pelvic floor muscle training (PFMT) ± biofeedback ᵃ
Comparison: No treatment (PFMT instruction only or no intervention) ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Urinary incontinence (within 3-6 months) | Favours intervention | GRADE assessment not performed for this outcome |
Urinary incontinence (after 12 months) | Favours intervention | Moderate |
Incontinence episodes per day (3-6 months) | Favours intervention | GRADE assessment not performed for this outcome |
Pad usage (3-6 months) | No statistically significant difference | GRADE assessment not performed for this outcome |
Quality of life (3-6 months) | No statistically significant difference | GRADE assessment not performed for this outcome |
No improvement in urinary incontinence; incontinence episodes per day (≥1 year); pad usage (≥1 year); quality of life (≥1 year); adverse effects | - | None of the studies identified by the review assessed these outcomes |
Note ᵃ This evidence table summarises the findings for the comparison PFMT ± biofeedback versus no treatment, which is the main comparison as stated in the Cochrane review Summary of Findings table. See the full CCA for information on other comparisons (anal electric stimulation versus no treatment; combination of treatments versus no treatment; active treatment versus alternative active treatment). PMFT was defined as “any method of training the pelvic floor muscles to contract”. There was considerable variation in the actual intervention (including intensity) in the included studies (see Cochrane Review for more information). Studies that included biofeedback generally used surface electrodes or digital or anal probes. For all other comparisons evaluated “no firm conclusions could be drawn regarding effectiveness or safety”. See the CCA for more information.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Men with prostate cancer who experienced drug-induced hot flushes
Intervention: Intervention for the management of hot flushes (paroxetine; clonidine; gabapentin)
Comparison: Placebo
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Paroxetine versus placebo | ||
Hot flush composite score | Favours intervention | Low |
Hot flush frequency | Favours intervention | Low |
Clonidine versus placebo | ||
Hot flush composite score | Favours intervention | Low |
Hot flush frequency | No statistically significant difference | Low |
Gabapentin versus placebo | ||
Hot flush composite score | No statistically significant difference | Low |
Hot flush frequency | No statistically significant difference | High |
Recommendations as stated in the source guideline For men with prostate cancer who are experiencing drug- or surgery-induced hot flushes, the panel suggests paroxetine or clonidine rather than no treatment for the management of symptoms (strength of recommendation: conditional; certainty of evidence: low). For patients with cancer who are experiencing drug- or surgery-induced hot flushes, the panel suggests against gabapentin or pregabalin (gabapentinoids) for the management of symptoms (strength of recommendation: conditional; certainty of evidence: very low).
Note The guideline included systematic review and network meta-analysis (NMA) data. The results in this table are based on the NMA which includes indirect comparisons. Results from the systematic reviews (which the guideline states could not be pooled in the network) were reported narratively in the guideline without any mention of GRADE. The recommendations made by the guideline panel were based on the totality of the evidence, which therefore does not correlate completely with the outcome-based evidence ratings in the body of this table. The NMA includes paroxetine, clonidine, sertraline, fluoxetine, escitalopram, and duloxetine, which the guideline panel recommend rather than no treatment for men with prostate cancer and drug-induced hot flushes. Of these drugs, paroxetine and clonidine are favoured. The guideline panel noted the overall lack of evidence in men experiencing hot flashes. Adverse event data was extrapolated from female breast cancer literature, while noting that tolerability may differ in men.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
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