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Prostate Cancer Treatment in New Hampshire Evolves with New Understanding, Technology

April 17, 2015
Lebanon, NH

There are signs of improved treatments for prostate cancer among New Hampshire men, according to a recent Dartmouth-Hitchcock  Norris Cotton Cancer Center study.

Urologist Elias Hyams, MD and epidemiologist Judith Rees, MPH, PhD, published their findings "Trends in initial management of prostate cancer in New Hampshire," in Cancer Causes & Control. They detail trends of less aggressive treatment of "low-risk" cancer and increasing use of surgical procedures for "high-risk" disease.

"These are novel data regarding statewide practice patterns in the management of localized, non-metastatic prostate cancer," said Hyams. "We are encouraged. Physicians in New Hampshire appear to be following evidence-based guidelines in favoring a conservative treatment approach for 'low-risk' cancer, which is known to be slow growing and may never cause harm."

The strategies for management of prostate cancer have changed over time and continue to do so as understanding of the disease becomes more nuanced. The emerging evidence supports physicians' observation of "low-risk" prostate cancer, but aggressive, curative therapy for "high risk" cancer.

The Dartmouth team evaluated trends in management of prostate cancer in New Hampshire utilizing the New Hampshire State Cancer Registry records from 2004-2011. Treatment modalities were recorded as surgery, radiation therapy, expectant management, or hormone therapy. Their findings included more frequent use of surgery for "high-risk" cases, which is a distinctly more aggressive approach to that level of disease that can be effective alone, or in combination with radiation therapy. Use of hormone therapy as a singular approach for localized "high-risk" disease is now uncommon, and that is consistent with previous evidence finding hormone therapy to not be curative and a frequent cause of significant side effects.

"The advent of robotic surgery, which decreases the invasiveness of surgical therapy, has likely contributed to the willingness of physicians to use surgery to treat patients with 'high-risk' disease," explained Hyams.

Looking forward, Hyams and Rees are using Registry data to evaluate factors such as travel time to a radiation center that may influence patients' decisions to pursue surgery, radiation, or observation as an initial management strategy for their prostate cancer.

Hyams is Assistant Professor of Surgery and of Urology at Dartmouth's Geisel School of Medicine and he treats urology patients at Dartmouth-Hitchcock Medical Center in Lebanon and New London Hospital in New London, NH. Rees is Assistant Professor of Community & Family Medicine Dartmouth's Geisel School of Medicine and Assistant Professor at The Dartmouth Institute. Their work in cancer is facilitated by Dartmouth's Norris Cotton Cancer Center where Rees is a member of the Cancer Epidemiology Research Program.

Additional collaborators on this project were Michael Laviolette, PhD, MPH who is Senior Statistical Analyst of the Bureau of Public Health Statistics and Informatics, New Hampshire Division of Public Health Services; Johann Ingimarsson, MD resident physician at Dartmouth-Hitchcock Medical Center; and Maria O. Celaya, MPH, CTR Assistant Director of Field Operations for the New Hampshire State Cancer Registry.

About Norris Cotton Cancer Center at Dartmouth-Hitchcock

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center in Lebanon, NH, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at

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