Introduction
Prostate cancer is second only to lung cancer as the most frequently occurring type of cancer in men. The incidence of prostate cancer in the Netherlands is approximately 95 in 100,000 men per year (Kankerregistratiegegevens 2003¹). This means that more than 7,900 new patients are diagnosed with prostate cancer in the Netherlands each year. Notably, the incidence of prostate cancer increased in the early 1990s, by about 40% between 1989 and 1994. The incidence remained high but stable until 2003, when it increased again by 6%. The most frequently occurring type is adenocarcinoma originating in the prostatic ducts. Cases of localised prostate cancer are increasingly diagnosed, and have led to a decrease in the average age at diagnosis. These observations have all been linked to the increasingly wider application of testing for the biomarker prostate-specific antigen (PSA), which allows for detection of the disease in its early stages. Therefore, it is very unlikely that an actual increase in the incidence of prostate cancer has occurred. Mortality rates due to prostate cancer decreased in the second half of the 1990s, which has been attributed to improvements in detection and treatment. The incidence of prostate cancer increases gradually after the age of 40 years, and the frequency of prostate cancer in elderly men is very high. Accounting for expansion among the elderly and general populations, the number of men with prostate cancer is expected to increase by about 64% between 2000 and 2020 (Van Oers 2002²).

Determining a rational approach to the management of prostate cancer is hindered in many ways by the general lack of adequate studies. Most of the data on treatment is derived from analyses of results from single institutions, and there is some difference of opinion regarding the value of various treatment options. The high incidence of prostate cancer and the many treatment options available underscore the need for a collective national guideline.

Because no national guideline existed, the Dutch Urological Association (Nederlandse Vereniging voor Urologie) took the initiative to develop a multidisciplinary, evidence-based guideline for the diagnosis and treatment of prostate cancer. Methodological expertise and logistical support was provided by the Dutch Institute for Healthcare Improvement (Kwaliteitsinstituut voor de Gezondheidszorg CBO). Project coordination and secretaryship was provided by the Association of Comprehensive Cancer Centres (Vereniging van Integrale Kankercentra).

Goal
This guideline contains recommendations to aid in daily practice. The guideline is based on the results of scientific research and expert opinion aimed at establishing good medical practice. What is presented should be generally considered as the best care for patients with prostate cancer.

The guideline provides recommendations for diagnosis, treatment, follow-up, and counselling of patients with prostate cancer. Screening is not discussed and no recommendations regarding screening are made, given the lack of sufficient scientific evidence. The goal is to provide guidance for daily practice that is applicable to all patients with prostate cancer, irrespective of stage. The guideline can be used when counselling patients. It also offers a starting point for developing local protocols (regional or institutional) and/or arrangements for transmural care to promote implementation.

Target audience
This guideline is intended for all healthcare professionals involved in the diagnosis, treatment, and counselling of patients with prostate cancer, such as urologists, radiation oncologists, medical oncologists, general practitioners, oncology nurses, consultants for integrated cancer centres, pathologists, social workers, psychologists, radiologists, and nuclear medicine physicians. The guideline may also be given to patients and their family members.

Background information
Composition of the working group (see appendix 17)

• Methods of the working group (see appendix 18)
• Scientific argumentation (see appendix 19)
• Development of the recommendations (see appendix 20)
• Implementation and evaluation (see appendix 21)
• Legal implications (see appendix 22)
• Revisions (see appendix 23)
• Colophon (see appendix 24)
• Basis questions (see appendix 25)
• Summary of recommendations (see appendix 26)
• Definitions and abbreviations (see appendix 27)
• Participating organisations (see appendix 28)
• The patient information brochure 'Prostaatkanker' produced by the Dutch Cancer Society (KWF) can be downloaded here.