PSA SCREENING AND PROSTATE CANCER MORTALITY

描述：（改编自申请人摘要）。 前列腺特异 前列腺特异性抗原（PSA）筛查预防前列腺癌死亡和残疾 自1989年以来在美国得到了广泛的应用。 美国癌症 社会建议所有50岁以上的男性都做这种血液检查 每年，有证据表明，大多数50-79岁的男性 至少做过一次测试 虽然筛查导致了 癌症的诊断以及因此的根治性前列腺手术， 预防这种疾病死亡的有效性尚未得到证实。 前列腺癌 死亡率继续上升。 一项基于人群的病例对照研究 PSA筛查被认为是最及时的方法来评估这一点 主要的筛选模式。 这些研究已成功地用于 评估其他筛查方式，并基于以下概念： 筛查可以预防死亡，死者应该不太可能患有 比人群中的可比男性进行筛查。 病例将为55-79 一名30岁的新泽西已婚男子，死于前列腺癌，死于1998-2000年。 已婚对照组将从随机数字拨号（年龄55-64岁）或 从联邦医疗保险文件（年龄65-79），并将匹配的情况下，年龄 和种族。 病例和对照家庭将接受采访，以确定所有 自1989年以来的医疗保健来源，并获得许可审查这些 PSA筛查记录。 所有住院和门诊提供者将 联系，以确定自1989年以来PSA筛查的情况。 分析将 重点是1989年至1999年期间是否对病例进行了筛查。 诊断. 一个完全可比的日历时间段将在 对照 保护程度（以前列腺疾病的比值比衡量） 将计算与筛选相关的癌症死亡率（小于1.0） 调整潜在混杂因素前后的变化。 本研究 建议提供PSA有效性的第一个直接估计 筛查前列腺癌死亡率。

DESCRIPTION: (Adapted from Applicant's Abstract). Prostate specific antigen (PSA) screening to prevent death and disability from prostate cancer has come into widespread use in the U.S. since 1989. The American Cancer Society recommends that all men over age 50 have this blood test done annually, and there is evidence that a majority of 50-79 year old men have had the test at least once. While screening has led to a major increase in the diagnosis of cancer and, consequently, i radical prostate surgeries, its efficacy in preventing death from this disease is unproven. Prostate cancer mortality has continued to increase. A population-based, case-control study of PSA screening is proposed as the most timely approach to evaluate this major screening modality. These studies have been used successfully to evaluate other screening modalities and are predicated on the notion that if screening prevents mortality, the decedents should be less likely to have been screened than comparable men in the population. Cases will be 55-79 year old, married, New Jersey men, dying of prostate cancer in 1998-2000. Married controls will be selected from random digit dialing (age 55-64) or from Federal Medicare files (age 65-79) and will be matched to cases on age and race. Case and control families will be interviewed to ascertain all sources of medical care since 1989 and secure permission to review these records for PSA screening. All inpatient and outpatient providers will be contacted to ascertain instances of PSA screening since 1989. Analysis will focus on whether or not cases were screened from 1989 to the time of diagnosis. An exactly comparable calendar time period will be studied in controls. The extent of protection (measured as an odds ratio for prostate cancer death of less than 1.0) associated with screening will be calculated before and after adjustment for potential confounders. This study is proposed to provide the first direct estimate of the effectiveness of PSA screening on prostate cancer mortality.