PORT-II FOR PROSTATIC DISEASES

前列腺疾病的 PORT-II

• 批准号: 2591646
• 负责人: MICHAEL J BARRY
• 金额: $ 137.21万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-01 至 1999-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2591646
• 关键词: alpha antiadrenergic agent; benign prostate hyperplasia; early diagnosis; health care model; histopathology; human subject; human therapy evaluation; longitudinal human study; male; male reproductive system disorder diagnosis; metastasis; neoplasm /cancer chemotherapy; neoplasm /cancer epidemiology; neoplasm /cancer immunodiagnosis; neoplasm /cancer radiation therapy; oxidoreductase inhibitor; patient care management; primary care physician; prostate neoplasms; prostate specific antigen; prostate surgery; tumor antigens

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.

该提案描述了针对前列腺疾病的 PORT-II，它将 继续前列腺疾病患者结果研究小组的工作 (PORT-I) 由 AHCPR 从 1989 年至 1994 年资助了五年。良性 前列腺增生（BPH）和前列腺癌（CAP）是两种疾病 老年男性极其常见的疾病； 40%的男性最终会 诊断为 BPH，13% 诊断为 CAP。该项目的目标是 定义当前的筛查、诊断和治疗模式 初级保健医生和泌尿科医生的前列腺疾病，以更好地 确定肿瘤 CAP 筛查的有效性和成本 标记前列腺特异性抗原 (PSA)，以更好地确定有效性 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 初级保健机构中患有前列腺疾病的男性的结果。 用于实现这些目标的方法将包括在全国范围内进行调查 初级保健医生和泌尿科医生；的开发和模拟 CAP 筛查的随机模型；一个多机构 对大约 3000 名接受过治疗的男性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；以及人口比较—— 基于康涅狄格州（该地区 CAP 的治疗不太积极）和西雅图地区（该地区 CAP 治疗更加积极）。此外，一项随机试验 为患者和医生提供教育计划，帮助改善管理 前列腺疾病的诊断将在初级保健网络中进行 实践，达特茅斯合作伙伴。作为这次试验的副产品，我们将 确定接受药物治疗的 BPH 男性患者的结果（5-α 还原酶抑制剂或α-I肾上腺素能受体拮抗剂）或 “观察等待”策略，揭示PSA真实需求 在初级保健机构中对消息灵通的男性进行测试。 最后，我们将继续从 PORT-I 开始的过程，监测新的 前列腺疾病领域的发展，紧跟变化 在实践模式中，通过索赔数据更新、标准化 从患者的数据中获取治疗结果的测量 的观点，启动新兴技术的早期评估， 参与临床有效性试验的设计和进行， 并将结果传播给提供者、患者和政策制定者。