Patient Outcomes Research Team (PORT-II) for Prostatic Diseases;Final rept. 1 Sep 94-31 Aug 00

摘要

The PORT-II for Prostatic Diseases was a multidisciplinary effort to better define the outcomes of treatment of benign and malignant prostate disease. The goals of the project were to define current patterns of screening, diagnosis, and treatment of prostate disease; to better define the effectiveness and cost of screening for prostate cancer with the tumor marker prostate specific antigen (PSA); to better define the effectiveness of aggressive treatment of clinically localized prostate cancer; and to define and optimize outcomes for men with prostatic diseases seen in primary care settings. These goals were addressed through a combination of prospective and retrospective cohort studies, large database analyses, randomized trials, and statistical modeling techniques. Findings from the various PORT projects include: (1) Primary care physicians were found to be more aggressive about PSA testing and referral for biopsy than most urologists would recommend, and radiation oncologists and urologists are significantly more likely to recommend their own specialty's treatment for patients with prostate cancer; (2) Modeling techniques utilizing data from the VA Normative Aging Study showed that the average age prostate cancer first developed, judging from the time the PSA level began to rise, is age 60, and that the estimated average duration of pre-clinical prostate cancer is 10 years; (3) Metastatic rates and long-term mortality among patients with clinically localized prostate cancer treated with radical prostatectomy, external beam radiation therapy, and expectant management were found to be different, but could have been explained by large differences in distributions of important prognostic factors among men in the different treatment groups; (4) More intensive screening and treatment with radical prostatectomy and external beam radiotherapy for prostate cancer among Medicare beneficiaries in the Seattle compared to the Connecticut SEER area was not associated with lower prostate cancer-specific mortality through 11 years of follow-up; and (5) An educational intervention aimed at both physicians and their patients (manuals and newsletters regarding prostate disease were distributed to physicians, their patients received mailed pamphlets targeted to their symptom level) was found to have no measurable impact on prostate related care.