Cancer Causes & Control

, Volume 26, Issue 6, pp 923–929 | Cite as

Trends in initial management of prostate cancer in New Hampshire

  • Johann P. Ingimarsson
  • Maria O. Celaya
  • Michael Laviolette
  • Judy R. Rees
  • Elias S. HyamsEmail author
Original paper



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.


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.


Of 6,203 clinically localized prostate cancers meeting inclusion criteria, 34, 30, and 28 % were low-, intermediate-, and high-risk disease, respectively. For low-risk 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.


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.


Prostate cancer Management trends Risk stratification Active surveillance Surgery 


Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Amercian Cancer Society (2015) Cancer facts and figures. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRefPubMedGoogle Scholar
  3. 3.
    Cooperberg MR, Broering JM, Carroll PR (2010) Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28(7):1117–1123. doi: 10.1200/JCO.2009.26.0133 CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Spångberg A, Andrén O, Palmgren J, Steineck G, Adami HO, Johansson JE (2014) Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med 370(10):932–942. doi: 10.1056/NEJMoa1311593 CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Daskivich TJ, Lai J, Dick AW, Setodji CM, Hanley JM, Litwin MS, Saigal C, Urologic Diseases in America Project (2014) Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer. Cancer 120(23):3642–3650. doi: 10.1002/cncr.28926
  6. 6.
    Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM, AUA Prostate Cancer Clinical Guideline Update Panel (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177(6):2106–2131CrossRefPubMedGoogle Scholar
  7. 7.
    Mohler JL, Armstrong AJ, Bahnson RR, Boston B, Busby JE, D’Amico AV, Eastham JA, Enke CA, Farrington T, Higano CS, Horwitz EM, Kantoff PW, Kawachi MH, Kuettel M, Lee RJ, MacVicar GR, Malcolm AW, Miller D, Plimack ER, Pow-Sang JM, Roach M 3rd, Rohren E, Rosenfeld S, Srinivas S, Strope SA, Tward J, Twardowski P, Walsh PC, Ho M, Shead DA (2012) Prostate cancer, Version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 10(9):1081–1087PubMedGoogle Scholar
  8. 8.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N, European Association of Urology (2013) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137. doi: 10.1016/j.eururo.2013.09.046 CrossRefPubMedGoogle Scholar
  9. 9.
    Bechis SK, Carroll PR, Cooperberg MR (2011) Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 29(2):235–241. doi: 10.1200/JCO.2010.30.2075 CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Roberts CB, Albertsen PC, Shao YH, Moore DF, Mehta AR, Stein MN, Lu-Yao GL (2011) Patterns and correlates of prostate cancer treatment in older men. Am J Med 124(3):235–243. doi: 10.1016/j.amjmed.2010.10.016 CrossRefPubMedGoogle Scholar
  11. 11.
    Potosky AL, Haque R, Cassidy-Bushrow AE, Ulcickas Yood M, Jiang M, Tsai HT, Luta G, Keating NL, Smith MR, Van Den Eeden SK (2014) Effectiveness of primary androgen-deprivation therapy for clinically localized prostate cancer. J Clin Oncol 32(13):1324–1330. doi: 10.1200/JCO.2013.52.5782 CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Sun M, Sammon JD, Becker A, Roghmann F, Tian Z, Kim SP, Larouche A, Abdollah F, Hu JC, Karakiewicz PI, Trinh QD (2014) Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: a comparative effectiveness evaluation. BJU Int 113(2):200–208. doi: 10.1111/bju.12321 CrossRefPubMedGoogle Scholar
  13. 13.
    Stewart SB, Boorjian SA (2014) Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol S1078–1439(14):00344–00345. doi: 10.1016/j.urolonc.2014.10.003 Google Scholar
  14. 14.
    van Tol-Geerdink JJ, Willem Leer J, Weijerman PC, van Oort IM, Vergunst H, van Lin EN, Alfred Witjes J, Stalmeier PF (2013) Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid. BJU Int 111(4):564–573. doi: 10.1111/j.1464-410X.2012.11402.x CrossRefPubMedGoogle Scholar
  15. 15.
    Han LC, Delpe S, Shah ND, Ziegenfuss JY, Tilburt JC, Karnes RJ, Nguyen PL, Gross CP, Yu JB, Trinh QD, Sun M, Ranasinghe WK, Kim SP (2014) Perceptions of radiation oncologists and urologists on sources and type of evidence to inform prostate cancer treatment decisions. Int J Radiat Oncol Biol Phys 89(2):277–283. doi: 10.1016/j.ijrobp.2014.02.001 CrossRefPubMedGoogle Scholar
  16. 16.
    Hoffman RM, Koyama T, Fan KH, Albertsen PC, Barry MJ, Goodman M, Hamilton AS, Potosky AL, Stanford JL, Stroup AM, Penson DF (2013) Mortality after radical prostatectomy or external beam radiotherapy for localized prostate cancer. J Natl Cancer Inst 105(10):711–718. doi: 10.1093/jnci/djt059 CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Nepple KG, Stephenson AJ, Kallogjeri D, Michalski J, Grubb RL 3rd, Strope SA, Haslag-Minoff J, Piccirillo JF, Ciezki JP, Klein EA, Reddy CA, Yu C, Kattan MW, Kibel AS (2013) Mortality after prostate cancer treatment with radical prostatectomy, external-beam radiation therapy, or brachytherapy in men without comorbidity. Eur Urol 64(3):372–378. doi: 10.1016/j.eururo.2013.03.005 CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Barry MJ, Zietman A, O’Leary M, Walker-Corkery E, Yao SL (2009) Outcomes of localized prostate cancer following conservative management. JAMA 302(11):1202–1209. doi: 10.1001/jama.2009.1348 CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28(1):126–131. doi: 10.1200/JCO.2009.24.2180 CrossRefPubMedGoogle Scholar
  20. 20.
    Thomsen FB, Brasso K, Klotz LH, Røder MA, Berg KD, Iversen P (2014) Active surveillance for clinically localized prostate cancer—a systematic review. J Surg Oncol 109(8):830–835. doi: 10.1002/jso.23584 CrossRefPubMedGoogle Scholar
  21. 21.
    Weiner AB, Patel SG, Etzioni R, Eggener SE (2015) National trends in the management of low and intermediate risk prostate cancer in the United States. J Urol 193(1):95–102. doi: 10.1016/j.juro.2014.07.111 CrossRefPubMedGoogle Scholar
  22. 22.
    Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL (2008) Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med 148(6):435–448CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS Jr, Faraday MM (2013) Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol 190(2):441–449. doi: 10.1016/j.juro.2013.05.032 CrossRefPubMedGoogle Scholar
  24. 24.
    Lee SY, Friderici J, Stefan MS, Rothberg MB (2014) Impact of the 2008 US preventative services task force recommendation on frequency of prostate‐specific antigen screening in older men. J Am Geriatr Soc 62(10):1912–1915. doi: 10.1111/jgs.13061 CrossRefPubMedGoogle Scholar
  25. 25.
    Celaya MO, Rees JR, Gibson JJ, Riddle BL, Greenberg ER (2006) For women with early-stage breast cancer in a predominantly rural population (United States). Cancer Causes Control 17(6):851–856CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Johann P. Ingimarsson
    • 1
  • Maria O. Celaya
    • 2
    • 3
  • Michael Laviolette
    • 4
  • Judy R. Rees
    • 2
    • 3
  • Elias S. Hyams
    • 1
    Email author
  1. 1.Section of Urology, Department of SurgeryDartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.New Hampshire State Cancer RegistryLebanonUSA
  3. 3.Geisel School of MedicineHanoverUSA
  4. 4.New Hampshire Division of Public Health ServicesBureau of Public Health Statistics and InformaticsConcordUSA

Personalised recommendations