PORT-II FOR PROSTATIC DISEASES

这项提议描述了一个用于前列腺癌的Port-II，它将 继续前列腺癌患者结局研究小组的工作 (i港)由AHCPR资助，从1989-1994年再持续五年。良性 前列腺增生(BPH)和前列腺癌(CAP)是两种 老年男性非常常见的疾病；40%的男性最终将患上 诊断为良性前列腺增生症(BPH)和慢性前列腺炎(CAP)。该项目的目标是 确定当前筛查、诊断和治疗的模式 前列腺癌在初级保健医生和泌尿科医生中的作用 确定肿瘤患者CAP筛查的有效性和成本 标志物前列腺特异性抗原(PSA)，以更好地定义有效性 对临床局限性前列腺癌的积极治疗 根治性前列腺切除术或放射治疗，并定义和优化 在初级保健环境中看到的患有前列腺癌的男性的结果。 用于实现这些目标的方法将包括一项全国性的调查 初级保健医生和泌尿科医生.发展和模拟 CAP筛查的随机模型；多机构 对大约3000名男性患者进行的回顾性队列研究 期待治疗，根治性前列腺切除术，或放射治疗 至少十年的随访；与人口的比较- 基于康涅狄格州的转移率和死亡率(该地区 CAP的治疗不那么积极)和西雅图地区( CAP治疗更积极)。此外，一项关于 针对病人和医生的教育计划，以帮助改善管理 将在初级保健网络中进行前列腺癌的治疗 练习，达特茅斯鸡舍。作为这项试验的副产品，我们将 确定接受药物(5-α)治疗的良性前列腺增生症患者的结果 还原酶抑制剂或α-I受体拮抗剂)或 “警惕等待”战略，揭开PSA的真实需求 在初级保健环境中的知情男子中进行测试。 最后，我们将继续在第一港开始的进程，监测新的 前列腺病领域的发展，与时俱进 在实践中通过索赔数据更新的模式，标准化 从患者的治疗结果中获取治疗结果的测量 视角，启动对新兴技术的早期评估， 参与临床疗效试验的设计和实施； 并向提供者、患者和政策制定者传播结果。

This proposal describes a PORT-II for prostate diseases, which would continue the work of a Patient Outcome Research Team for prostate diseases (PORT-I) funded by AHCPR from 1989-1994 for five more years. Benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CAP) are two exceedingly common diseases of older men; 40% of men will eventually be diagnosed with BPH and 13% with CAP. The goals of the project are to define the current pattern of screening, diagnosis, and treatment of prostate disease among primary care physicians and urologists, to better define the effectiveness and cost of screening for CAP with the tumor marker prostate specific antigen (PSA), to better define the effectiveness of aggressive treatment of clinically localized prostate cancer with radical prostatectomy or radiation therapy, and to define and optimize outcomes for men with prostatic diseases seen in primary care settings. The methods used to address the goals will include a nationwide survey of primary care physicians and urologists; the development and simulation of a stochastic model of screening for CAP; a multi-institutional retrospective cohort study of approximately 3000 men treated with expectant management radical prostatectomy, or radiation therapy with a minimum of ten years of follow-up; and a comparison of the population- based rates of metastatic disease and death in Connecticut (a region where treatment of CAP is less aggressive) and the Seattle area (a region where CAP treatment is more aggressive). In addition, a randomized trial of an educational program for patients and physicians to help improve management of prostate disease will be conducted in a network of primary care practices, the Dartmouth COOP. As a by-product of this trial, we would determine the outcomes for men with BPH treated with medication (5-alpha reductase inhibitors or alpha-I adrenergic receptor antagonists) or a strategy of "watchful waiting", and uncover the true demand for PSA testing among well-informed men in primary care settings. Finally, we would continue the process, begun in PORT-I, of monitoring new developments in the field of prostatic diseases, keeping up with changes in practice patterns through claims data updates, standardizing measurements that capture treatment outcomes from the patient's perspective, initiating early assessments of emerging technologies, participating in the design and conduct of clinical effectiveness trials, and disseminating results to providers, patients, and policy-makers.