12. Research questions – Prostate Cancer

The guideline group has identified a need for research in many areas of prostate cancer diagnosis and treatment. In the context of the first update, the members of the guideline group were asked for specific research questions. Following a selection by the steering group, these questions which directly relate to the guideline itself, or to topics discussed in the guideline are listed below. Additional topics were identified during the process of working through the topics for the second update. No research questions were included on aspects to be researched in another update. Foundational research questions were also not included.

1. Health services research

It is not clear to what extent the guideline contents are applied in practice and what influence this has on care.

The guideline group therefore strongly supports the development of guideline application evaluation programs. In particular, the members of the steering group and patient representatives are happy to provide advice on the design of evaluation studies. This includes health economic analyses of the various primary treatment procedures.

2. Pathomorphological examinations

The guideline group supports studies to validate biopsy evaluation and markers for aggressiveness assessment of carcinomas.

3. Diagnosis and treatment of localized and locally-advanced prostate cancer

The guideline group supports studies of imaging techniques, particularly ultrasound and MRI techniques, that use and validate comparable technical standards and have clinically relevant endpoints.

The guideline group sees a need for research on the indication of active surveillance in patients with intermediate-risk tumors, and on the indication of brachytherapy alone in patients with intermediate-risk tumors, or brachytherapy in combination with percutaneous radiotherapy and/or hormone deprivation therapy in high-risk patients.

The guideline group sees a need for research regarding appropriate comorbidity classifications for decision making with regard to early detection, diagnosis, and treatment of prostate cancer.

4. Diagnosis and treatment of recurrence

The guideline group sees a priority need for research regarding the following questions:

• benefit of PET/CT in biochemical recurrence (PSA level >1ng/ml) prior to salvage radiotherapy or salvage lymphadenectomy
• benefits and harms of surgical treatment of recurrence after percutaneous radiotherapy
• value of HIFU in the treatment of recurrence
• treatment of regional lymph node progression
  
  

5. Diagnosis and treatment of metastatic castration-resistant prostate cancer

The guideline group sees a need for research on the following topics:

• imaging for the diagnosis of metastases
• sequential treatment of different treatment options
• head-to-head comparisons of different treatment options