Prostate-Specific Antigen Practices and Outcomes in the Elderly

老年人前列腺特异性抗原的实践和结果

• 批准号: 8456902
• 负责人: Louise C. Walter
• 金额: $ 21.12万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8456902
• 关键词: Adopted; Adverse effects; Advisory Committees; Age; Androgens; Area; Belief; Biopsy; Clinical; Cohort Studies; Comorbidity; Data; Databases; Decision Aid; Decision Making; Development; Disease; Elderly; Elderly man; Electronic Health Record; Event; Gender; Guidelines; Health system; Intervention; Life Expectancy; Link; Location; Malignant neoplasm of prostate; Marital Status; Measures; Medicare; Medicare claim; Minority; Outcome; Patients; Performance; Preventive; Primary Health Care; Process; Prostate; Prostate-Specific Antigen; Provider; Public Health; Publishing; Race; Radiation; Radical Prostatectomy; Recording of previous events; Rewards; Screening for Prostate Cancer; Services; Socioeconomic Factors; Staging; Symptoms; Testing; United States; Universities; Veterans; Work; abstracting; aged; cancer diagnosis; cohort; combat; deprivation; design; human old age (65+); improved; innovation; men; older men; randomized trial; screening

Project Summary/Abstract Prostate-specific antigen (PSA) screening for the early detection of prostate cancer has been widely adopted in the U.S. among elderly men, including those with limited life expectancy. Such screening is grounded in pervasive beliefs that screening is always the safest course of action, despite the uncertain benefit of PSA screening. Therefore, this proposal makes innovative use of VA and Medicare claims-based data and electronic health records to determine factors associated with PSA screening and the downstream consequences following screening in elderly men across a spectrum of advancing age and comorbid illness. This includes men with favorable 10-year life expectancy for whom several guidelines recommend screening, and men with limited life expectancy for whom screening is unlikely to be beneficial. Such data are fundamental for informed PSA screening decisions among the many elderly men who are considering screening and for the development of quality measures that reward clinicians for avoiding excessive testing. This application proposes a cohort study of 826,908 men aged 65 years and older who were seen at 104 Veterans Affairs (VA) facilities during 2002 and 2003, without a history of prostate cancer, elevated PSA, or prostate cancer symptoms. VA data and Medicare claims will be used to measure the performance of PSA testing during 2003 as well as the health-system, provider, and patient-level determinants of screening and the downstream consequences following screening. Subsets of men will also be selected to obtain richer clinical detail from electronic health records about additional determinants and consequences of screening. The aims of this project are 1) to determine the health-system, provider, and patient factors associated with PSA screening in elderly men across a spectrum of advancing age and comorbid illness; 2) to quantify the real world downstream consequences (e.g., PSA testing, prostate biopsies, cancer diagnosis, treatment, and complications) during the 3 years following PSA screening in elderly men across a spectrum of advancing age and comorbid illness; and 3) to identify health-system, provider, and patient factors associated with these downstream consequences. Factors associated with PSA screening and initiating each step in the cascade of downstream consequences will be identified according to life expectancy to determine where targeted interventions are needed to discourage excessive testing in elderly men.

项目总结/文摘

项目成果

Five-year downstream outcomes following prostate-specific antigen screening in older men.

• DOI: 10.1001/jamainternmed.2013.323
• 发表时间: 2013-05-27
• 期刊: JAMA INTERNAL MEDICINE
• 影响因子: 39
• 作者: Walter, Louise C.;Fung, Kathy Z.;Kirby, Katharine A.;Shi, Ying;Espaldon, Roxanne;O'Brien, Sarah;Freedland, Stephen J.;Powell, Adam A.;Hoffman, Richard M.
• 通讯作者: Hoffman, Richard M.

Incorporating lag time to benefit into prevention decisions for older adults.

• DOI: 10.1001/jama.2013.282612
• 发表时间: 2013-12-25
• 期刊: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
• 影响因子: 120.7
• 作者: Lee, Sei J.;Leipzig, Rosanne M.;Walter, Louise C.
• 通讯作者: Walter, Louise C.

80 is the new 60: implications of irrational exuberance regarding longevity on prostate cancer treatment decisions.

80 岁是新的 60 岁：关于长寿的非理性繁荣对前列腺癌治疗决策的影响。

• DOI: 10.1007/s11606-012-2006-8
• 发表时间: 2012
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Freedland,StephenJ;Walter,LouiseC
• 通讯作者: Walter,LouiseC

Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result.

他汀类药物与前列腺特异性抗原筛查结果异常的可能性较低有关。

• DOI: 10.1016/j.urology.2014.06.069
• 发表时间: 2014
• 期刊: Urology
• 影响因子: 2.1
• 作者: Shi,Ying;Fung,KathyZ;Freedland,StephenJ;Hoffman,RichardM;Tang,VictoriaL;Walter,LouiseC
• 通讯作者: Walter,LouiseC

Senior adult oncology.

• DOI: 10.6004/jnccn.2012.0019
• 发表时间: 2012-02
• 期刊: Journal of the National Comprehensive Cancer Network : JNCCN
• 作者: Hurria A;Browner IS;Cohen HJ;Denlinger CS;deShazo M;Extermann M;Ganti AK;Holland JC;Holmes HM;Karlekar MB;Keating NL;McKoy J;Medeiros BC;Mrozek E;O'Connor T;Petersdorf SH;Rugo HS;Silliman RA;Tew WP;Walter LC;Weir AB 3rd;Wildes T
• 通讯作者: Wildes T