The measure developer confirms that both actions cannot start simultaneously, the test results listed below with the criterion "starts before the start" must be documented PRIOR to the subsequent action (and not be documented during the same time or encounter). See the updated example below, for further clarification:   The measure specification criteria ‘starts before start of’ means STARTS PRIOR TO  Most recent PSA <= 10 MUST be present PRIOR to the start of Clinical Staging Procedure  AND Most recent Gleason Score < = 6 MUST be present PRIOR to the start of Prostate Cancer Treatment  AND Most recent Clinical Staging Procedure result of T1c/T2c MUST be present PRIOR to the start of Prostate Cancer Treatment