COMPARISON OF TREATMENT EFFICACY FOR PROSTATE CANCER

自前列腺特异性抗原（PSA）检测在美国推出以来， 20世纪80年代后期，局限性前列腺癌的新发病例数 急剧上升。 围绕着这种疾病的治疗存在争议 因为没有随机试验明确证明积极的 治疗与保守治疗。 我们的研究目标是 获得更准确的估计根治性 手术和放射治疗，通过确定是否需要二次 癌症治疗和患者生存时间（按关键词分层） 已知的影响生存的变量。 使用康涅狄格肿瘤 注册表（CTR）作为一个病例发现工具，我们建议组装一个 超过4000名男性被诊断为局部 前列腺癌在1990 - 1992年期间，并遵循他们 前瞻性地实现以下具体目标：对于那些 接受了根治性手术，放射治疗或没有立即 作为他们的主要治疗，我们将（1）确定频率 在社区接受治疗的男性中进行二次癌症治疗的时间 （2）确定血清PSA升高的频率和时间 在社区实践中接受治疗的男性中，（3）确定十年 接受治疗的男性的病因特异性和全因生存结局 社区实践。所有结果将根据 以下已知影响进展和生存的变量： 患者年龄、人种、合并症、诊断性活检肿瘤组织学 通过Gleason评分估计，通过活检前估计肿瘤体积 PSA水平。 使用从该患者队列中收集的数据，我们将讨论 以下问题：（1）男性如何进行根治性手术， 放射治疗或不立即治疗根据年龄而不同， 人种、合并症、诊断性活检组织学或治疗前PSA？ (2)接受二次癌症治疗的相对风险是多少 在初次治疗的十年内， 手术、放射治疗或控制后不立即治疗 患者年龄、种族、合并症、诊断性活检组织学或 治疗前PSA？（3）患者年龄的相对能力， 人种、合并症、诊断性活检组织学或治疗前PSA 来预测疾病的进展，导致特异性和全因生存？ 由于CTR持续监测患者的生命状态， 在登记处，本研究提供的信息最终将 允许进行15年和20年全因和特定原因生存分析， 整个队列。

Since the introduction of prostate specific antigen (PSA) testing in the late 1980's, the number of new cases of localized prostate cancer has risen dramatically. Controversy surrounds the treatment of this disease because no randomized trials clearly document the benefit of aggressive treatment versus conservative management. Our research goal is to obtain more accurate estimates of the treatment efficacy of radical surgery and radiation therapy by determining the need for secondary cancer therapy and the length of patient survival stratified by key variables known to impact survival. Using the Connecticut Tumor Registry (CTR) as a case finding tool, we propose to assemble a population-based cohort of over 4000 men diagnosed with localized prostate cancer during the period 1990-1992 and follow them prospectively to achieve the following specific aims: For men who received either radical surgery, radiation therapy or no immediate therapy as their primary therapy, we will (1) Determine the frequency and timing of secondary cancer therapies among men treated in community practices, (2) Determine the frequency and timing of serum PSA elevation among men treated in community practices, (3) Determine the ten year cause-specific and all-cause survival outcomes for men treated in community practices. All results will be stratified according to the following variables that are known to impact progression and survival: patient age, race, co-morbidities, diagnostic biopsy tumor histology estimated by the Gleason score, and tumor volume estimated by pre-biopsy PSA level. Using data collected from this cohort of patients, we will address the following questions: (1) How to do men undergoing radical surgery, radiation therapy or no immediate treatment differ according to age, race, comorbidities, diagnostic biopsy histology or pre-treatment PSA? (2) What is the relative risk of receiving secondary cancer therapy within ten years of initial treatment for men undergoing radical surgery, radiation therapy or no immediate treatment after controlling for patient age, race, co-morbidities, diagnostic biopsy histology or pre-treatment PSA? and (3) What is the relative ability of patient age, race, co-morbidities, diagnostic biopsy histology or pre-treatment PSA to predict disease progression, cause specific and all-cause survival? Since the CTR continually monitors the vital status of patients included in the registry, information available from this study will eventually permit 15 and 20 year all-cause and cause-specific survival analyses for the entire cohort.