Impact of screening and diagnostic intensity on the study of prostate cancer epidemiology

项目摘要 许多生活方式因素已被检查为可能的前列腺癌风险因素，但结果 在研究中不一致。有可能是由于未能充分考虑PSA筛查的差异 诊断强度解释了其中的一些不一致。 20世纪80年代末，前列腺癌PSA筛查的引入对前列腺癌的治疗产生了重大影响。 前列腺癌流行病学，发病率持续增加，向更局部化的疾病转变， 降低死亡率。无论是筛查还是愿意接受前列腺活检， PSA升高后的手术与各种人口统计学和生活方式因素有关。这些 男性PSA筛查和活检行为的差异可能会扭曲生活方式因素的估计影响 前列腺癌的风险，但很少有人尝试定量评估这种可能的偏见来源。 我们的科学前提是，适当考虑筛查和活检的影响是必要的， 阐明生活方式因素和前列腺癌风险之间的潜在联系。 本项目的目的是研究筛查和活检倾向对 人口统计学和生活方式因素与前列腺癌之间的关联。这将支持更严格的 解读现有的前列腺癌流行病学研究并为数据收集和分析提供信息 未来研究的方法。我们将使用来自一个大型的、正在进行的队列的数据， 研究（HPFS），一个独特的资源，收集了关于使用PSA筛查和前列腺 自1996年以来，每两年进行一次活检，并更新了一系列生活方式因素的信息， 前列腺癌的诊断和生存的信息。在目标1中，我们将研究前列腺的模式 癌症筛查和活组织检查与（a）人口统计学和生活方式因素有关，包括：年龄，种族， 家族史、吸烟、肥胖、体力活动、饮食和药物使用，和（B）具有前列腺风险 癌在目标2中，我们将使用几种分析方法来研究这些生活方式因素是如何关联的 与前列腺癌风险无关，与筛查和活检实践无关。 这项研究有效地利用了现有数据的独特收集，提供了第一个全面的 评估前列腺癌筛查和诊断行为对前列腺癌风险的影响 因素通过表征和量化这种检测偏差，该项目将有助于解释现有的 前列腺癌危险因素的研究，并为未来的数据收集和分析研究提供方向 以更好地处理这些问题。总的来说，我们希望这项工作将阐明以前的 前列腺癌风险因素的研究结果不一致，并支持更严格的风险识别 前列腺癌的因素，支持公共卫生预防工作。

PROJECT SUMMARY Many lifestyle factors have been examined as possible prostate cancer risk factors, but results are inconsistent across studies. It is possible that failure to adequately account for differences in PSA screening and diagnostic intensity explains some of these inconsistencies. The introduction of PSA screening for prostate cancer in the late 1980s has had a major impact on prostate cancer epidemiology, with a sustained increase in incidence rates, a shift to more localized disease, and decreased mortality rates. Both screening and willingness to undergo a prostate biopsy, the diagnostic procedure that follows an elevated PSA, are associated with various demographic and lifestyle factors. These differences in men’s PSA screening and biopsy behaviors may distort the estimated effects of lifestyle factors on prostate cancer risk, but few attempts have been made to quantitatively assess this source of possible bias. Our scientific premise is that appropriately accounting for the impact of screening and biopsy is necessary to elucidate the underlying associations between lifestyle factors and prostate cancer risk. The objective of this project is to study the impact of screening and propensity for biopsy on the association between demographic and lifestyle factors and prostate cancer. This will support more rigorous interpretation of existing studies of prostate cancer epidemiology and inform data collection and analytic methods for future studies. We will use data from a large, on-going cohort, the Health Professionals Follow-up Study (HPFS), a unique resource which has collected information on the use of PSA screening and prostate biopsy every two years since 1996, and also has updated information on an array of lifestyle factors, and information on prostate cancer diagnosis and survival. In Aim 1, we will investigate how patterns of prostate cancer screening and biopsy are associated (a) with demographic and lifestyle factors, including: age, race, family history, smoking, obesity, physical activity, diet, and medication usage, and (b) with risk of prostate cancer. In Aim 2, we will use several analytic approaches to study how these lifestyle factors are associated with prostate cancer risk, independent of screening and biopsy practices. This study efficiently leverages a unique collection of existing data to provide the first comprehensive assessment of the impact of prostate cancer screening and diagnosis behaviors on prostate cancer risk factors. By characterizing and quantifying this detection bias, this project will aid in the interpretation of existing studies of prostate cancer risk factors and provide direction to future studies on data collection and analytic methods to better handle these issues. Overall, we hope that this work will shed light on previous inconsistencies in findings on prostate cancer risk factors and support more rigorous identification of risk factors for prostate cancer, supporting public health prevention efforts.