Pezzino G, Remington P L, Anderson H A, Harms L, Phillips J L, Bruskewitz R, Peterson D
Division of Health, Wisconsin Department of Health and Social Services, Madison.
J Natl Cancer Inst. 1994 Jul 20;86(14):1083-6. doi: 10.1093/jnci/86.14.1083.
Radical prostatectomy (removal of the prostate gland and seminal vesicles) is usually considered a definitive treatment for localized prostate cancer. Although a sharp increase and wide geographic variation in radical prostatectomy rates have been recently documented, the reasons for this increase and the factors that make men diagnosed with the disease more likely to be treated surgically are not well known.
Our purpose was to examine trends in the use of surgical treatment for prostate cancer, as well as the factors associated with the choice of surgical treatment and how these factors changed in Wisconsin in the period 1989 through 1991.
We carried out a population-based cohort study. A cohort of Wisconsin men diagnosed from 1989 through 1991 with prostate cancer was identified through the Wisconsin cancer reporting system. To determine which men diagnosed with prostate cancer were treated with surgery, we linked prostate cancer records to the Wisconsin hospital discharge database. The outcome measured was radical prostatectomy within 6 months from the date of the diagnosis of prostate cancer.
The yearly number of prostate cancer cases reported from 1989 through 1991 rose 33%, from 2468 to 3278. During the same period, the yearly number of radical prostatectomies rose 226%, from 283 to 922. Patients diagnosed in 1991 were twice as likely to have surgery as those diagnosed in 1989, the proportion of cases receiving surgical treatment rising from 12% to 25%. Patients who were white, less than 65 years of age, had a cancer reported to be at regional stage, and who were first reported by large hospitals were more likely to be treated surgically.
The use of surgery to treat prostate cancer has increased dramatically in Wisconsin, doubling in a 3-year period, despite the fact that studies have not shown surgery to be more effective than other options for many patients. The increase observed in the rate of surgery was about the same across age, race, stage at diagnosis, and hospital size. The reasons for this increase are probably multifactorial.
Risks, costs, and benefits of surgical treatment should be carefully compared with those of alternative management approaches. Patients should be enabled to make an informed decision, based on the current best evidence, on the treatment option they prefer.
根治性前列腺切除术（切除前列腺和精囊）通常被认为是局限性前列腺癌的确定性治疗方法。尽管最近已记录到根治性前列腺切除术的发生率急剧上升且存在广泛的地域差异，但这种上升的原因以及使被诊断患有该疾病的男性更有可能接受手术治疗的因素尚不清楚。
我们的目的是研究前列腺癌手术治疗的使用趋势，以及与手术治疗选择相关的因素，以及这些因素在1989年至1991年期间在威斯康星州是如何变化的。
我们进行了一项基于人群的队列研究。通过威斯康星州癌症报告系统确定了1989年至1991年期间被诊断患有前列腺癌的威斯康星州男性队列。为了确定哪些被诊断患有前列腺癌的男性接受了手术治疗，我们将前列腺癌记录与威斯康星州医院出院数据库进行了关联。测量的结果是自前列腺癌诊断之日起6个月内进行的根治性前列腺切除术。
1989年至1991年报告的前列腺癌病例年数增加了33%，从2468例增至3278例。在同一时期，根治性前列腺切除术的年数增加了226%，从283例增至922例。1991年被诊断的患者接受手术的可能性是1989年被诊断患者的两倍，接受手术治疗的病例比例从12%升至25%。白人、年龄小于65岁、报告癌症处于区域阶段且首次由大型医院报告的患者更有可能接受手术治疗。
在威斯康星州，尽管研究表明手术对许多患者并不比其他选择更有效，但使用手术治疗前列腺癌的情况仍急剧增加，在3年内增加了一倍。在年龄、种族、诊断阶段和医院规模方面，观察到的手术率增加情况大致相同。这种增加的原因可能是多方面的。
应仔细比较手术治疗与其他管理方法的风险、成本和益处。应使患者能够根据当前的最佳证据，就他们喜欢的治疗方案做出明智的决定。
