Faculty Bibliography

PURPOSE: We evaluated in patients with prostate cancer whether treatment is associated with in decreased mortality and whether the association of treatment with mortality varies with calendar time. MATERIALS AND METHODS: Using the 146,979 prostate cancer patients from the 1973 to 1990 public use tape of the Surveillance, Epidemiology and End Results program, we performed survival analysis and multivariate proportional hazards modeling to estimate the relative risk of disease specific and overall mortality. RESULTS: In men with prostate cancer, advanced age, black race, high tumor stage and not having treatment were independently associated with disease specific and overall mortality. The relative risk of mortality in treated patients decreased significantly from 1973 to 1990. CONCLUSIONS: The fact that advanced age and black race are associated with disease specific mortality (even when treatment and stage are controlled) is a new observation, which suggests that tumor biology and/or response to treatment is worse in elderly and black men. Overall, the data are consistent with the hypothesis that treatment of prostate cancer is associated with lower disease specific and overall mortality rates. The decreases in relative mortality in treated patients from 1973 to 1990 indirectly support the theory that changes in patterns of care from 1973 to 1990 had a beneficial effect on mortality. This observation implies that future studies should account for calendar time when interpreting outcomes data.

Depression is common and treatable, but the burden of awareness is the patient's. It is the physical symptoms of depression that bring people into a doctor's office

When new studies are released, patients should consider them as updates, not the final word on a therapy or an illness. Medicine is more of an art than a science, and it should be tailored to meet an individual patient's needs. Therefore, not every new breakthrough will apply to every patient

Lamm, a physician, notes that he always feels "a sense of trepidation when a patient comes in complaining of stomach pain." Abdominal pain that is continous, severe, or accompanied by a fever warrants medical care

People with allergies should take comfort in the fact they they don't have to suffer. Important aspects of allergy care--such as prevention and early treatment--are discussed

The standard approach to treating obesity, which affects 20-30% of all Americans, does not work, and physicians need to develop new ways to help obese people. Treatment beyond behavior modification is needed as there appears to be a very real physiological basis for obesity