P. Pinsky, Ruth Etzioni, N. Howlader, P. Goodman, I. Thompson
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引用次数: 5
Abstract
The Prostate Cancer Prevention Trial (PCPT) recently demonstrated a significant reduction in prostate cancer incidence of about 25% among men taking finasteride compared to men taking placebo. However, the effect of finasteride on the natural history of prostate cancer is not well understood. We adapted a convolution model developed by Pinsky (2001) to characterize the natural history of prostate cancer in the presence and absence of finasteride. The model was applied to data from 10,995 men in PCPT who had disease status determined by interim diagnosis of prostate cancer or end-of-study biopsy. Prostate cancer cases were either screen-detected by Prostate-Specific Antigen (PSA), biopsy-detected at the end of the study, or clinically detected, that is, detected by methods other than PSA screening. The hazard ratio (HR) for the incidence of preclinical disease on finasteride versus placebo was 0.42 (95% CI: 0.20-0.58). The progression from preclinical to clinical disease was relatively unaffected by finasteride, with mean sojourn time being 16 years for placebo cases and 18.5 years for finasteride cases (p-value for difference = 0.2). We conclude that finasteride appears to affect prostate cancer primarily by preventing the emergence of new, preclinical tumors with little impact on established, latent disease.
期刊介绍:
The International Journal of Biostatistics (IJB) seeks to publish new biostatistical models and methods, new statistical theory, as well as original applications of statistical methods, for important practical problems arising from the biological, medical, public health, and agricultural sciences with an emphasis on semiparametric methods. Given many alternatives to publish exist within biostatistics, IJB offers a place to publish for research in biostatistics focusing on modern methods, often based on machine-learning and other data-adaptive methodologies, as well as providing a unique reading experience that compels the author to be explicit about the statistical inference problem addressed by the paper. IJB is intended that the journal cover the entire range of biostatistics, from theoretical advances to relevant and sensible translations of a practical problem into a statistical framework. Electronic publication also allows for data and software code to be appended, and opens the door for reproducible research allowing readers to easily replicate analyses described in a paper. Both original research and review articles will be warmly received, as will articles applying sound statistical methods to practical problems.