PORT-II FOR PROSTATIC DISEASES

该提案描述了前列腺疾病的PORT-II， 继续前列腺疾病患者结局研究小组的工作 （PORT-I）由AHCPR从1989-1994年供资，为期五年。良性 前列腺增生（BPH）和前列腺癌（CAP）是两种 老年男性的常见疾病; 40%的男性最终会 诊断为BPH和13%的CAP。该项目的目标是 明确目前的筛查、诊断和治疗模式， 在初级保健医生和泌尿科医生中， 确定筛查肿瘤CAP的有效性和成本 标志物前列腺特异性抗原（PSA），以更好地定义有效性 积极治疗临床局限性前列腺癌， 根治性乳房切除术或放射治疗，并确定和优化 在初级保健机构中看到的前列腺疾病男性的结局。 实现这些目标所采用的方法将包括在全国范围内调查 初级保健医生和泌尿科医生;发展和模拟 CAP筛选的随机模型;多机构 回顾性队列研究，约3000名男性接受 期待治疗根治性直肠癌切除术，或放射治疗， 至少10年的随访;和人口的比较- 基于康涅狄格州转移性疾病和死亡率（该地区 CAP的治疗不太积极）和西雅图地区（一个 CAP治疗更具侵略性）。此外，一项随机试验显示， 为患者和医生提供教育计划，以帮助改善管理 前列腺疾病将在初级保健网络中进行 实践，达特茅斯合作社。作为这次审判的副产品， 确定前列腺增生症男性患者接受药物治疗（5-α 还原酶抑制剂或α-I肾上腺素能受体拮抗剂）或 “静观其变”的战略，揭示PSA的真实需求 在初级保健机构中对消息灵通的男性进行测试。 最后，我们将继续在第一阶段开始的监测新的 前列腺疾病领域的发展，跟上变化 通过索赔数据更新、标准化 从患者的治疗结果中捕获的测量 展望，启动对新兴技术的早期评估， 参与临床有效性试验的设计和实施， 并将结果传播给提供者、患者和决策者。

This proposal describes a PORT-II for prostate diseases, which would continue the work of a Patient Outcome Research Team for prostate diseases (PORT-I) funded by AHCPR from 1989-1994 for five more years. Benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CAP) are two exceedingly common diseases of older men; 40% of men will eventually be diagnosed with BPH and 13% with CAP. The goals of the project are to define the current pattern of screening, diagnosis, and treatment of prostate disease among primary care physicians and urologists, to better define the effectiveness and cost of screening for CAP with the tumor marker prostate specific antigen (PSA), to better define the effectiveness of aggressive treatment of clinically localized prostate cancer with radical prostatectomy or radiation therapy, and to define and optimize outcomes for men with prostatic diseases seen in primary care settings. The methods used to address the goals will include a nationwide survey of primary care physicians and urologists; the development and simulation of a stochastic model of screening for CAP; a multi-institutional retrospective cohort study of approximately 3000 men treated with expectant management radical prostatectomy, or radiation therapy with a minimum of ten years of follow-up; and a comparison of the population- based rates of metastatic disease and death in Connecticut (a region where treatment of CAP is less aggressive) and the Seattle area (a region where CAP treatment is more aggressive). In addition, a randomized trial of an educational program for patients and physicians to help improve management of prostate disease will be conducted in a network of primary care practices, the Dartmouth COOP. As a by-product of this trial, we would determine the outcomes for men with BPH treated with medication (5-alpha reductase inhibitors or alpha-I adrenergic receptor antagonists) or a strategy of "watchful waiting", and uncover the true demand for PSA testing among well-informed men in primary care settings. Finally, we would continue the process, begun in PORT-I, of monitoring new developments in the field of prostatic diseases, keeping up with changes in practice patterns through claims data updates, standardizing measurements that capture treatment outcomes from the patient's perspective, initiating early assessments of emerging technologies, participating in the design and conduct of clinical effectiveness trials, and disseminating results to providers, patients, and policy-makers.