Trends in Prostate Cancer -- United States, 1980-1988

Among men, carcinoma of the prostate is the second most common cancer and the second most common cause of death from cancer in the United States (1). During 1992, an estimated 132,000 men will be diagnosed with and 34,000 will die from prostate cancer (2). This report describes trends in prostate cancer incidence and mortality by patients' age, race, and state of residence from 1980 through 1988.

Incident cases * by age and race for 1980-1988 were determined using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The age, race, and state of residence of persons who died during 1980-1988 were determined using the underlying cause of death ** from the multiple cause-of-death data files compiled by CDC's National Center for Health Statistics. The denominators for both rates were derived from intercensal population estimates. Rates were standardized to the 1970 age distribution of the U.S. male population. To obtain statistically stable rates, age- and race-specific incidence and death rates were computed for a 5-year period by using annual data aggregated during the most recent 5-year period (1984-1988). Race-specific rates are not reported for races other than white and black because sufficient denominators were not available.

From 1980 through 1988, age-adjusted prostate cancer incidence rates increased steadily for both black and white men (8% and 30%, respectively) (Figure 1). During this period, although the incidence rate was higher for black men than for white men, the rate ratio decreased from 1.6 in 1980 to 1.3 in 1988. For men of both races, incidence rates varied directly with age (Figure 2); the highest age-specific incidence rates occurred for white men aged greater than or equal to 85 years and black men aged 80-84 years. The difference in annual age-specific incidence rates by race was greatest for the youngest age group (i.e., 50-54 years); for black men, the rate was 2.1 times greater than for white men (63.9 per 100,000 population versus 30.2 per 100,000).

From 1980 through 1988, death rates increased 2.5% for white men and 5.7% for black men. For each year, the age-adjusted prostate cancer death rate for black men was approximately two times higher than that for white men. However, for men of both races, death rates increased with age and were higher for men aged greater than or equal to 85 years. The age-specific difference was greatest for men aged 50-54 years: in this age group, the death rate for black men was 3.1 times higher than that for white men (12.2 per 100,000 versus 3.9 per 100,000). This difference varied inversely with age; the rate ratio was 1.3 in the oldest age group (i.e., greater than or equal to 85 years).

Prostate cancer death rates varied by state (Table 1). For white men, rates ranged from 18.9 per 100,000 in Arkansas to 28.0 per 100,000 in Vermont. For black men, rates ranged from 29.8 per 100,000 in Minnesota to 55.5 per 100,000 in the District of Columbia and North Carolina.

Reported by: Office of Surveillance and Analysis, and Div of Cancer Prevention and Control, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that the incidence of prostate cancer in the United States has increased steadily since 1980, especially for white men; however, both the incidence and death rates remain higher for black men. Although the magnitude of this difference in incidence has diminished since 1980, the twofold higher death rate for black men has persisted, and the disparity by race has been greatest for younger age groups. One potential explanation for this difference is that prostate cancer has been more likely to be diagnosed at a later disease stage for black men than for white men (3). When stratified by pathologic stage, however, survival differences have been similar by race (4).

Although the etiology of prostate cancer is not clearly understood, age, genetic influences, and environmental conditions may be important risk factors (2). The increasing incidence of prostate cancer may reflect, in part, an increase in the frequency of screening. Recent studies have demonstrated that the use of prostate-specific antigen (PSA) and transrectal ultrasound (TRUS) in conjunction with digital rectal examination (DRE) may be useful for early detection of prostate cancer (5-7). Therefore, the increasing incidence rate of prostate cancer for white men since 1984 may be associated, in part, with the greater availability and use of these new diagnostic methods (8). In addition, because blacks may seek health care later or have less access to medical care, the availability of case information for whites may have been more complete than that for blacks in the SEER program.

Public health surveillance efforts at the state and local levels (e.g., physician-based surveillance systems, ambulatory-care surveys, hospitalization data, and cancer registries) may assist in further explaining the trends. Legislation to improve state cancer registration is pending; improved population-based cancer registries should enable state and local health departments to monitor the impact of early detection efforts on incidence rates and stage at diagnosis.

The primary goal of any cancer-screening test and subsequent program should be to reduce disease-specific mortality. Despite the improved effectiveness of PSA, TRUS, and DRE to detect disease at earlier stages, these methods have not yet been associated with a reduction in prostate cancer mortality (9). Although the likelihood of 5-year survival with prostate cancer has increased, death rates for prostate cancer have not been reduced substantially (10). Thus, the value of both mass screening for prostate cancer and screening targeted to younger black men is unclear. Continued surveillance of cause-specific mortality should assist in determining whether screening efforts are successful in detecting earlier disease and whether early treatment of disease is effective.

References

1. American Cancer Society. Cancer facts and figures -- 1992. Atlanta: American Cancer Society, 1992.

2. Badalament RA, Drago JR. Prostate cancer. Dis Mon 1991;4:203-68.

3. Murphy GP, Natarajan N, Pontes JE, et al. The National Survey of Prostate Cancer in the United States by the American College of Surgeons. J Urol 1982;127:928-34.

4. Levine RL, Wilchensky M. Adenocarcinoma of the prostate: a comparison of the disease in blacks versus whites. J Urol 1979;121:761-2.

5. Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH. Screening for prostatic carcinoma with prostate specific antigen. J Urol 1992;147:841-5.

6. Muschenheim F, Omarbasha B, Kardjian PM, Mondou EN. Screening for carcinoma of the prostate with prostate specific antigen. Ann Clin Lab Sci 1991;21:371-80.

7. Lee F, Littrup PJ, Loft-Christensen L, et al. Predicted prostate specific antigen results using transrectal ultrasound gland volume: differentiation of benign prostatic hyperplasia and prostate cancer. J Natl Cancer Inst (in press).

8. Thompson IM. Carcinoma of the prostate: changing incidence associated with annual urologic screening. South Med J 1989;82:335-7.

9. Gerber GS, Chodak GW. Routine screening for cancer of the prostate. J Natl Cancer Inst 1991;83:329-35.

10. Chodak GW. Prostate cancer: to screen or not to screen. Acta Oncol 1991;30:285-7.

• International Classification of Diseases for Oncology, code 185.9. ** International Classification of Diseases, Ninth Revision, code 185.

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