DESCRIPTION (provided by applicant): There are a number of reasons to be concerned about treatment-related harm in prostate cancer. First, it is a disease that primarily affects elderly males -- two-thirds are over age 65 at the time of diagnosis - and older patients, in general, are more vulnerable to the side effects of treatment. Second, there is a broad spectrum of prostate cancer: some patients have rapidly progressive disease and are destined to suffer and die from metastases, while others have disease that progresses very slowly (or not at all) and will never become symptomatic during their lifetime. Patients in the latter group can gain nothing from treatment and can only be harmed. Finally, there has been a tremendous increase in the number of men diagnosed with prostate cancer over the past 20 years -- meaning that even small risks of treatment-related harm end up affecting thousands of men. This project has two aims: 1). Assess mortality attributable to prostate cancer not currently captured in prostate cancer mortality. 2). Characterize medical interventions and outcomes that are a consequence of prostate cancer diagnosis and treatment. Our approach begins by using SEER-Medicare data to assemble a cohort of men who receive a prostate biopsy. The cohort will be followed to observe the differences in care processes and outcomes among men found and not found to have prostate cancer. We will also compare the mortality of these groups and will consider the difference to be a measure of "treatment inclusive" prostate cancer mortality. This, in turn, will be compared to prostate cancer mortality as measured using death certificates to determine whether an undercount exists. The entire process will be repeated on a cohort of men who receive a transurethral resection of the prostate.
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