title: Trends in initial management of prostate cancer in New Hampshire.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, johann.p.ingimarsson@hitchcock.org.
authors.forename: Johann P
authors.initials: JP
authors.lastname: Ingimarsson
authors.forename: Maria O
authors.initials: MO
authors.lastname: Celaya
authors.forename: Michael
authors.initials: M
authors.lastname: Laviolette
authors.forename: Judy R
authors.initials: JR
authors.lastname: Rees
authors.forename: Elias S
authors.initials: ES
authors.lastname: Hyams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011467:Prostate / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen