PROSTATE CANCER: A RETROSPECTIVE SURVIVAL ANALYIS

尽管前列腺癌目前是导致癌症的第二大原因 男性死亡，局限性前列腺癌的治疗仍在继续 有争议的。根本的问题是缺乏关于 疾病的自然病史和缺乏足够的随访 关于当前治疗策略的有效性的数据。三 各种因素使确定适当的治疗方法变得更加紧迫。 对于局限性前列腺癌：1.美国男性活到了 当无症状前列腺癌广泛流行时，他们70岁的S和80岁的S， 2.直肠超声及弹簧活检术等新技术 已经采用了枪支，允许识别以前的 未被发现的癌症，以及3.泌尿科医生重新表现出热情 用于早期前列腺癌的积极治疗。治疗费用是 每箱远远超过10,000美元，但它们对老年男性有利吗？ 适当的治疗选择围绕着这样一个问题：对于男性 对于新诊断的前列腺癌，预期寿命和 发病率的降低是通过侵略性的发病率和费用来实现的 治疗？为了解决这个问题，一组1463名男性被诊断出患有 1971年至1980年间的局部性疾病已通过 康涅狄格州肿瘤登记处。至少十年的随访期是 在89%的病例中可用。对这个队列的生存分析表明 每年因前列腺癌导致的2%的超额死亡率。 本项目建议对该患者进行详细的回顾分析。 队列，以计算疾病特定死亡率 未经治疗的前列腺癌。这一比率将与 与患者接受治疗相关的疾病特定死亡率 根治性手术、放射治疗和即时内分泌操作。 患者队列将根据年龄、肿瘤组织学和患者共同情况进行控制 回溯性研究范围内的发病率。这些信息 将为前列腺癌的自然发展提供新的见解 并提供了必要的统计和伦理基础 构建病例对照研究和治疗算法。

Although prostate cancer is currently the second leading cause of cancer deaths in men, the treatment of localized prostate cancer remains controversial. The fundamental problem is a lack of knowledge concerning the natural history of the disease and the absence of adequate follow up data concerning the efficacy of current treatment strategies. Three factors have created a new urgency to determining the appropriate treatment for localized prostate cancer: 1. American men are surviving well into their 70's and 80's when asymptomatic prostate cancer is widely prevalent, 2. new technology including rectal ultrasound and the spring loaded biopsy gun has been adopted which permits the identification of previously undetectable cancers, and 3. urologists have shown a renewed enthusiasm for aggressive treatment of early prostate cancer. Treatment costs are well over $10,000/case, but do they benefit the older male? The appropriate therapeutic choice revolves around the question: For men with newly diagnosed prostate cancer, what increase in life expectancy and decreased morbidity is gained by the morbidity and expense of aggressive therapy? To address this question, a cohort of 1463 men diagnosed with localized disease between 1971 and 1980 has been identified using the Connecticut State tumor registry. A minimum ten year follow up is available on 89% of the cases. Survival analysis of this cohort suggests a constant 2% annual excess mortality rate due to prostate cancer. This project proposes a detailed retrospective analysis of this patient cohort in order to calculate the disease specific mortality rate for untreated adenocarcinoma of the prostate. This rate will be compared with the disease specific mortality rate associated with patients undergoing radical surgery, radiation therapy and immediate endocrine manipulation. Patient cohorts will be controlled for age, tumor histology and patient co- morbidities within the limits of a retrospective study. The information provided will yield new insights into the natural progression of prostate cancer and provide the necessary statistical and ethical foundation for constructing case control studies and treatment algorithms.