PROSTATE CANCER SCREENING & MORTALITY: SEATTLE VS. CT.

说明：这是以前授予的重新提交。 调查人员 建议评估“自然实验”的结果，以确定是否 积极的早期发现和治疗努力可以有效地减少 前列腺癌的死亡率。 在美国， 西雅图SEER地区的临床医生更积极地试图 早期发现前列腺癌（特别是前列腺特异性抗原 或PSA测试）并积极治疗（特别是“PSA时代”（1987-1990）。 在前PSA时代，这些人群中基于人群的前列腺癌死亡率 两个基本上是一样的 他们的自然实验聚焦于 主要是在西雅图和康涅狄格州的大约75,000人的队列中 年龄在65-74岁之间（预期寿命至少为10年）， 至少到1990年，他们各自地区的居民。 期间 在1987-1990年期间，他们已经确定西雅图的男性 队列中接受前列腺活检的可能性是对照组的两倍， 被诊断出患有前列腺癌的可能性是患有前列腺癌的可能性的六倍。 根治性直肠癌切除术比康涅狄格州的男性患者多。 实际上 西雅图队列1987年至2010年根治性直肠癌切除术的累积发生率 1997年超过3%（这一群体中的男性比例将 预计最终死于前列腺癌），相比之下， 康涅狄格州的队列。 他们建议继续对这两个问题采取后续行动。 至2001日历年，或从开始实施 同伙 在这段时间里，他们希望看到 基于人群的前列腺癌死亡率西雅图与康涅狄格州相比 如果早期发现和积极的治疗， 社区确实是一个有效的策略。

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.