The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: a population-based cohort study
The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: a population-based cohort study
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DOI：
10.1111/j.1464-410x.2006.06416.x
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发表时间：
2006-11-01
影响因子：
4.5
通讯作者：
Wennberg, David C.
中科院分区：
文献类型：
--
作者：
Barry, Michael J.;Delorenzo, Michael A.;Wennberg, David C.
目的通过估计1993-2000年美国老年男性中雄激素剥夺治疗（ADT）的地区流行率，并将1987-91年的流行率与早期发现率和积极治疗率相关联，研究美国使用前列腺特异性抗原（PSA）检测早期发现前列腺癌的效果，因为一些作者预测ADT，作为这种努力的结果，传统上保留用于晚期前列腺癌的治疗随着时间的推移将变得不太常见。患者和方法在这项前瞻性的基于人群的队列研究中使用了5%的男性医疗保险受益人的样本。主要结果指标为ADT的总体患病率（内科和外科）在1993 - 2000年的队列中，以及1987-91年美国306个医院转诊地区前列腺手术率与1993 - 2000年这些地区ADT患病率之间的相关性。1993年下降到2000年的2.9%（P < 0.001）。1987 ~ 1991年前列腺活检率高的地区1993、1995、1997年ADT患病率高（P < 0.05）。1987-91年经尿道前列腺电切术率高的地区1993-2000年ADT患病率高（P < 0.01）。1987-91年根治性前列腺切除率较高的地区在1993-99年ADT率较高（P < 0.05）。结论随着时间的推移，美国广泛的前列腺癌早期发现和积极治疗与老年男性ADT的增加而非减少有关。
OBJECTIVE To investigate the effect of efforts in the early detection of prostate cancer using prostate-specific antigen (PSA) testing in the USA, by estimating the regional prevalence of androgen deprivation therapy (ADT) among older men in 1993-2000, and correlating the prevalence with early detection and aggressive treatment rates in 1987-91, as some authors predicted that ADT, a treatment traditionally reserved for advanced prostate cancer, would become less common over time as a result of such efforts.PATIENTS AND METHODS A sample of 5% of men who were Medicare beneficiaries was used in this prospective population-based cohort study. The main outcome measures were the overall prevalence of ADT (medical and surgical) in the cohort from 1993 to 2000, and correlations between rates of prostate procedures in the 306 USA hospital referral regions in 1987-91 and prevalence of ADT in those regions from 1993 to 2000.RESULTS The prevalence of ADT among these men in the USA increased steadily from 1.8% in 1993 to 2.9% in 2000 (P < 0.001). Regions with higher rates of prostate biopsy in 1987-91 had a higher prevalence of ADT in 1993, 1995 and 1997 (P < 0.05). Regions with higher rates of transurethral prostatectomy in 1987-91 had a higher prevalence of ADT in 1993-2000 (P < 0.01). Regions with higher rates of radical prostatectomy in 1987-91 had higher rates of ADT in 1993-99 (P < 0.05).CONCLUSIONS Widespread early detection and aggressive treatment for prostate cancer in the USA has been associated with more, not less, ADT among older men over time.