ASSESSMENT OF STRATEGIES FOR PROSTATE CANCER SCREENING

这里提出的工作的目标是评估替代方案， 前列腺癌的早期诊断 由于 随着男性寿命的增加，这种疾病已经成为一种主要的疾病。 美国的健康问题并承诺在未来的世界中 未来 尽管医学上取得了一些进展，但是， 与前列腺癌相关的死亡率并没有下降， 过去30年 一种解释是，很大一部分癌症是 诊断时无法治愈。 因此，降低死亡率的潜在方法 是通过常规筛查提高早期发现率，这一策略 对乳腺癌有效，但对肺癌无效。 费用 然而，常规筛查的规模是巨大的，其益处也不确定。 此外，尽管有适当的对照，随机筛选试验可能 如果不尽快启动，将无法为另一个 十到十五年。 因此，当务之急是， 为目前的前列腺管理确定筛查政策 癌 为了制定适当的政策，我们建议采用 决策分析，以评估不同的成本和效益， 替代品. 我们的总体目标是发展一种普遍的保健服务， 以初级保健医生指南的形式制定的政策， 患有不同共病的个体患者。 特定 我们工作的重点将是确定筛选的有效性 利用有限的资源，特别是适用于少数群体， 前列腺癌死亡率高， 预防保健。 我们的分析提出的一个重要问题是， 关于未经治疗的前列腺癌的自然史的信息。 因此，我们的工作很大一部分包括使用来自许多不同的数据 来源来估计我们模型的关键参数。 这些包括 关于发病率、死亡率和治疗的统计数据，以及来自 专门追踪未经治疗的结果的研究 患者 我们还广泛使用敏感性分析， 确定模型假设和参数变化的可能影响 价值观

The objective of the work proposed here is to evaluate alternative strategies for screening for carcinoma of the prostate. Due to the increasing fife expectancy of males, this disease has become a major health problem in the U.S., and promises to become more important in the future. Despite some medical progress, however, the disease-specific mortality rate associated with prostate cancer has not declined over the last 30 years. One explanation is that a large percentage of cancers is incurable at diagnosis. Thus, a potential approach to reducing mortality is to improve early detection by routine screening, a strategy that has proven effective for breast cancer though not for lung cancer. The costs of routine screening, however, are enormous and the benefits uncertain. Moreover, although properly controlled, randomized screening trials may be initiated soon, meaningful results will not be available for another 10-15 years. It is therefore imperative that the most appropriate screening policy be identified for the current management of prostate cancer. To develop appropriate policies, we propose to use the methodology of decision analysis to evaluate the costs and benefits of different alternatives. Our overall goal is to develop a general health care policy in the form of guidelines for primary care physicians and individual patients with different co-morbid conditions. A specific focus of our work will be to determine the effectiveness of screening using limited resources as especially applied to minority groups who have high mortality rates from prostate cancer and reduced access to preventive health care. An important issue raised by our analysis is the need for better information concerning the natural history of untreated prostate cancer. Thus, a large part of our work consists of using data from many different sources to estimate critical parameters of our model. These include statistics on incidence, mortality, and treatment, as well as data from studies that have specifically sought to track the outcome of untreated patients. We also make extensive use of sensitivity analysis to determine possible effects of changes in model assumptions and parameter values.