American Journal of Epidemiology Vol. 150, No. 8: 848-860
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health
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Role of Transurethral Resection of the Prostate in Population-based Prostate Cancer Incidence Rates
1Department of Health Science, Brigham Young University Provo, UT
2Division of Epidemiology, Department of Family and Preventive Medicine, University of Utah School of Medicine Salt Lake City, UT
3Applied Research Branch in the Division of Cancer Control and Population Sciences, National Cancer Institute Bethesda, MD
4Information Management Services, Inc. Silver Spring, MD
5Division of Urology, University of Utah School of Medicine Salt Lake City, UT
Reprint requests to Dr. Ray M. Merrill, Department of Health Science, Brigham Young University, Provo, UT 84602.
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. Am J Epidemiol 1999;150:848-60.
Medicare; prostatectomy; prostate-specific antigen; prostatic neoplasms; SEER Program
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