PORT-II FOR PROSTATIC DISEASES

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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.