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 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.
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.
Ingimarsson JP, Celaya MO, Laviolette M, Rees JR, Hyams ES. Are you the author?
Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Reference: Cancer Causes Control. 2015 Apr 4. Epub ahead of print.