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Cancer Causes and Control


Geisel School of Medicine


Purpose Prostate cancer management strategies are evolving with increased understanding of the disease. Specifically, there is emerging evidence that ‘‘low-risk’’ cancer is best treated with observation, while localized ‘‘high-risk’’ cancer requires aggressive curative therapy. In this study, we evaluated trends in management of prostate cancer in New Hampshire to determine adherence to evidence- based practice. Methods From the New Hampshire State Cancer Registry, cases of clinically localized prostate cancer diagnosed in 2004–2011 were identified and classified according to D’Amico criteria. Initial treatment modality was recorded as surgery, radiation therapy, expectant management, or hormone therapy. Temporal trends were assessed by Chi-square for trend. Results Of 6,203 clinically localized prostate cancers meeting inclusion criteria, 34, 30, and 28 % were low-, intermediate-, and high-risk disease, respectively. For lowrisk disease, use of expectant management (17–42 %, p\0.001) and surgery (29–39 %, p\0.001) increased, while use of radiation therapy decreased (49–19 %, p\0.001). For intermediate-risk disease, use of surgery increased (24–50 %, p\0.001), while radiation decreased (58–34 %, p\0.001). Hormonal therapy alone was rarely used for low- and intermediate-risk disease. For high-risk patients, surgery increased (38–47 %, p = 0.003) and radiation decreased (41–38 %, p = 0.026), while hormonal therapy and expectant management remained stable. Discussion There are encouraging trends in the management of clinically localized prostate cancer in New Hampshire, including less aggressive treatment of low-risk cancer and increasing surgical treatment of high-risk disease.