Merrill R M, Feuer E J, Warren J L, Schussler N, Stephenson R A
Department of Health Science, Brigham Young University, Provo, UT 84602, USA.
Am J Epidemiol. 1999 Oct 15;150(8):848-60. doi: 10.1093/oxfordjournals.aje.a010090.
The extensive pool of asymptomatic prostate disease in the population, which increases substantially with age, suggests that the frequent use of transurethral resection of the prostate (TURP) in recent decades has had a large effect on prostate cancer incidence. The authors identified the effect of TURP-detected prostate cancer on the observed incidence rates between 1973 and 1993 for men aged 65 years and older. They linked population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program to Medicare records between 1986 and 1993 to determine whether a TURP occurred sufficiently close to the time of a prostate cancer diagnosis for them to assume that it led to the diagnosis. TURP-detected cases prior to 1986 were calculated using an indirect method that involved multiplying the TURP procedure rate in the general population (from the National Hospital Discharge Survey) by estimates of the proportion of TURPs resulting in a prostate cancer diagnosis (from Medicare data and the literature). TURP explained much of the observed increase in overall prostate cancer incidence between 1973 and 1986 and possibly all of it in men aged 70 years and older. However, its influence on the trend and overall magnitude of the rates diminished between 1987 and 1993. The changing role of TURP in detecting prostate cancer is attributed to changes in medical technology and screening practices. The declining influence of TURP on prostate cancer incidence is likely to have continued beyond the study period due to the recent introduction and increasing use of medications for treating obstructive uropathy.
人群中存在大量无症状前列腺疾病，且其发病率随年龄大幅上升，这表明近几十年来频繁进行经尿道前列腺切除术（TURP）对前列腺癌发病率产生了重大影响。作者确定了1973年至1993年间TURP检测出的前列腺癌对65岁及以上男性观察到的发病率的影响。他们将监测、流行病学和最终结果计划中基于人群的癌症登记数据与1986年至1993年的医疗保险记录相链接，以确定TURP是否在前列腺癌诊断时间足够接近时发生，从而推断其导致了诊断。1986年之前TURP检测出的病例使用间接方法计算，该方法涉及将一般人群中的TURP手术率（来自国家医院出院调查）乘以导致前列腺癌诊断的TURP比例估计值（来自医疗保险数据和文献）。TURP解释了1973年至1986年间观察到的总体前列腺癌发病率增加的大部分情况，对于70岁及以上男性可能解释了全部情况。然而，1987年至1993年间其对发病率趋势和总体幅度的影响有所减弱。TURP在检测前列腺癌中作用的变化归因于医疗技术和筛查实践的改变。由于最近引入并越来越多地使用治疗梗阻性尿路病的药物，TURP对前列腺癌发病率的影响在研究期之后可能仍在持续下降。
