PROSTATE CANCER SCREENING & MORTALITY: SEATTLE VS. CT.

描述：这是上一次拨款的重新提交。调查人员 建议评估一项“自然实验”的结果，以确定 积极的早期发现和治疗努力有效地减少了 联邦医疗保险受益人的前列腺癌死亡率。在美国， 西雅图SEER地区的临床医生在尝试 及早发现前列腺癌(特别是前列腺癌特异性抗原 或PSA检测)，并积极对待(特别是“PSA时代”(1987-1990))。 在PSA之前的时代，基于人群的前列腺癌死亡率 两个现在和过去基本上是相同的。他们的自然实验关注的是 主要针对西雅图约75,000名男性和康涅狄格州95,000名男性 年龄65-74岁(预期寿命至少10岁)和 他们各自地区的居民至少要到1990年。在.期间 在1987-1990年间，他们已经确定西雅图的人 队列中接受前列腺活检的可能性大约是前者的两倍，后者是后者的两倍 被诊断出患有前列腺癌，接受 根治性前列腺切除术比康涅狄格州队列中的男性更多。事实上， 1987年以来西雅图队列中前列腺癌根治术的累积发病率 1997年超过3%(约占该队列中男性 预计最终将死于前列腺癌)，而 康涅狄格州的队列。他们建议继续对这两人进行后续行动 截至2001日历年的队列，或自 一群人。在这段时间里，他们预计会看到 西雅图与康涅狄格州人群前列腺癌死亡率的比较 如果早期发现和积极治疗，就像在 社区确实是一种有效的战略。

DESCRIPTION: This is a resubmission of a previous grant. The investigators propose to assess the outcomes of a "natural experiment" to determine whether aggressive early detection and treatment efforts are effective at reducing prostate cancer mortality for Medicare beneficiaries. In the United States, clinicians in the Seattle SEER area were much more aggressive in trying to detect prostate cancer early (particularly with the prostate-specific antigen or PSA test) and treat it aggressively (particularly "PSA era" (1987-1990). During the pre-PSA era, population-based prostate cancer mortality in these two are and was essentially identical. Their natural experiment focuses primarily on cohorts of about 75,000 men in Seattle and 95,000 men Connecticut who were age 65-74 (with at least a 10-year life expectancy) and who were residents of their respective regions through at least through 1990. During the period 1987-1990, they have already determined that the men in the Seattle cohort were about twice as likely to undergo prostate biopsy, twice as likely to be diagnosed with prostate cancer, and six times as likely to undergo a radical prostatectomy than men in the Connecticut cohort. In fact, the cumulative incidence of radical prostatectomy in the Seattle cohort from 1987- 1997 was over 3% (about the proportion of men in this cohort who would ultimately be expected to die of prostate cancer) compared to less than 1% in the Connecticut cohort. They propose to continue follow-up of these two cohorts through calendar year 2001, or 15 years from inceptions of the cohorts. Over this interval, they would expect to see a reduction in population-based prostate cancer mortality Seattle as compared to Connecticut if early detection and aggressive treatment as actually practiced in the community are indeed an effective strategy.