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Grant Details

Grant Number: 3U01CA088160-09S1 Interpret this number
Primary Investigator: Etzioni, Ruth
Organization: Fred Hutchinson Can Res Ctr
Project Title: Modeling Us Prostate Cancer Trends: Psa, Treatment & Ra*
Fiscal Year: 2009
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Abstract

DESCRIPTION (provided by applicant): This study aims to determine the population impact of changing strategies for prostate cancer control, by linking trends in disease incidence and mortality with trends in screening and treatment. The advent of PSA screening has transformed the way in which prostate cancer is detected and managed in the US. Today, the majority of prostate cancers in this country are screen-detected and localized. Increasing numbers of newly-diagnosed cases are being treated with hormone suppression therapy (HT), which has traditionally been reserved for advanced tumors. Cause-specific survival among prostate cancer cases has increased dramatically, but the real increase in life expectancy during the PSA era remains unclear. How have advances in screening and treatment contributed to prostate cancer death rates that have fallen by almost 30 percent since the early 1990s? And can racial disparities in patterns of care explain why mortality declines among African Americans are, only two-thirds of those among whites? We will use surveillance modeling to address these questions, building on our previous CISNET work, which modeled PSA screening. Our methods will combine simulation models and maximum likelihood analysis to address the following Specific Aims: (1) Estimate the real improvement in life expectancy among prostate cancer cases during the PSA era; (2) Quantify the contributions to mortality declines of PSA screening and HT, and evaluate whether the benefit of screening given growing use of HT exceeds the benefit that would be expected under standard therapies; (3) Determine whether racial differences in PSA screening and HT can account for the different mortality declines experienced by whites and African Americans; and (4) Address whether disease natural history differs according to race, by estimating lead times associated with PSA screening that are consistent with incidence trends in whites and African Americans. Our models will require reliable estimates of trends in screening and treatment, which we will obtain using SEER-Medicare data, as well as patient claims data from a large HMO based in Northern California. Through this work, our study promises to shed light on two of the most active controversies in prostate cancer research: the value of PSA screening versus advances in prostate cancer treatment, and the link between disparities in care and racial differences in prostate cancer outcomes.

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Publications

Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms.
Authors: Gulati R, Gore JL, Etzioni R
Source: Ann Intern Med, 2013 Feb 5;158(3), p. 145-53.
PMID: 23381039
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Limitations of basing screening policies on screening trials: The US Preventive Services Task Force and Prostate Cancer Screening.
Authors: Etzioni R, Gulati R, Cooperberg MR, Penson DM, Weiss NS, Thompson IM
Source: Med Care, 2013 Apr;51(4), p. 295-300.
PMID: 23269114
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Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates.
Authors: Gulati R, Mariotto AB, Chen S, Gore JL, Etzioni R
Source: J Clin Epidemiol, 2011 Dec;64(12), p. 1412-7.
PMID: 22032753
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How does early detection by screening affect disease progression? Modeling estimated benefits in prostate cancer screening.
Authors: Wever EM, Draisma G, Heijnsdijk EA, de Koning HJ
Source: Med Decis Making, 2011 Jul-Aug;31(4), p. 550-8.
EPub date: 2011 Mar 15.
PMID: 21406620
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Prostate-specific antigen screening in the United States vs in the European Randomized Study of Screening for Prostate Cancer-Rotterdam.
Authors: Wever EM, Draisma G, Heijnsdijk EA, Roobol MJ, Boer R, Otto SJ, de Koning HJ
Source: J Natl Cancer Inst, 2010 Mar 3;102(5), p. 352-5.
EPub date: 2010 Feb 8.
PMID: 20142584
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Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context.
Authors: Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, Feuer E, de Koning H
Source: J Natl Cancer Inst, 2009 Mar 18;101(6), p. 374-83.
EPub date: 2009 Mar 10.
PMID: 19276453
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Effect of population trends in body mass index on prostate cancer incidence and mortality in the United States.
Authors: Fesinmeyer MD, Gulati R, Zeliadt S, Weiss N, Kristal AR, Etzioni R
Source: Cancer Epidemiol Biomarkers Prev, 2009 Mar;18(3), p. 808-15.
EPub date: 2009 Mar 3.
PMID: 19258479
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Studies of prostate-cancer mortality: caution advised.
Authors: Etzioni R, Feuer E
Source: Lancet Oncol, 2008 May;9(5), p. 407-9.
PMID: 18452850
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Estimating lead time and overdiagnosis associated with PSA screening from prostate cancer incidence trends.
Authors: Telesca D, Etzioni R, Gulati R
Source: Biometrics, 2008 Mar;64(1), p. 10-9.
EPub date: 2007 May 14.
PMID: 17501937
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An ecologic study of prostate-specific antigen screening and prostate cancer mortality in nine geographic areas of the United States.
Authors: Shaw PA, Etzioni R, Zeliadt SB, Mariotto A, Karnofski K, Penson DF, Weiss NS, Feuer EJ
Source: Am J Epidemiol, 2004 Dec 1;160(11), p. 1059-69.
PMID: 15561985
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Prostate-specific antigen testing in black and white men: an analysis of medicare claims from 1991-1998.
Authors: Etzioni R, Berry KM, Legler JM, Shaw P
Source: Urology, 2002 Feb;59(2), p. 251-5.
PMID: 11834397
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