A critical need for national guidelines.

guideline recommendations while the language barrier was perceived as an obstacle for implementation. The team made use of existing guidelines of AUA, EAU, NICE, and EBRO in The Netherlands, next to the Cochrane library and PubMed for systematic reviews. Worldwide there is a need for guidance of clinicians in their daily work when faced with dilemmas and the need to take appropriate decisions. Physicians in university and community-based hospitals have become dependent on continuous medical education and clear and concise guidelines which help guide them to keep up with the ever growing number of clinical reports. The clinical landscape is constantly changing since patient populations at time of diagnosis change due to changes in lifestyle, new imaging techniques for diagnosing evolve, whereas novel treatment options including operational procedures and therapeutic compounds appear rather fast at the horizon. Practice guidelines clearly offer practical solutions to clinicians and need to be frequently updated to be useful to clinicians. According to Shekelle et al. [4], as a general rule, guidelines should be reassessed for validity every 3 years. A quick update process of a ‘living guideline’ is foreseen by the current steering committee. Guidelines are more likely to be adopted as long as there is a strong professional support and if the implementation does not result in increased healthcare costs. The German guidelines involved a wide range of experts, although this apparently did not always make the task easier. The public consultation before final editing of the guidelines is a remarkable and potentially valuable approach to keep close contact with the basis. This approach may preclude potential unwillingness of the patients to undergo a certain treatment and thus result in enhanced adherence to the guidelines developed. It would be of interest to obtain more detailed information why (only) 5 out of 23 comments received from the public consultation period were adopted. In this months’ issue of OnkOlOgie, Christoph Rölling and co-workers describe the rigorous and time-consuming developmental process which resulted in the interdisciplinary evidence based German S3 guidelines on diagnosis and treatment of prostate cancer [1]. The process encompassed a huge amount of work and was initiated by the German Society of Urology (DGU). The efforts took place over a period of several years, started in 2005 and were finalized and presented in September 2009. Rölling et al. provide detailed information concerning the composition of the group of different professional stakeholders, disciplines, involved in the development process, including members of the steering group, the research team involved in selecting, reviewing and rating the evidence, and individuals involved in formulating the final recommendations. Experts from 10 different medical societies or organizations, the Center for Quality in Medicine (Ärtzliches Zentrum fur Qualität in de Medizin, ÄZQ) and a patient organization were involved in the development of the guidelines. This process required several meetings over the years and additional re-evaluation steps. With this detailed report the authors adequately deal with the increasing concern about the quality, reliability and independence of practice guidelines since information on the methodological quality of the guidelines developed by specialty societies has not always been available [2]. In the past, guideline development has been largely based on expert opinion, and the views and opinions of other stakeholders [3]. In Germany, before 2005, apparently only one high quality, evidence based medicine (EBM) guideline existed (referred to as S3 according to the definition of the Scientific Medical Societies in Germany) and until then German guidelines in Urology were exclusively based on expert consensus of ‘evidence’ (level S1/S2). This asked for evidence based guidelines since various differences in the health care system limit the applicability of international evidence based