Prostate Cancer In New Jersey 1979-1996
Discussion

Recent Incidence and Mortality Trends

There has been a recent decline in the annual prostate cancer incidence rate among New Jersey men after a peak in 1992. Starting in the late 1980's, more men were screened using methods such as prostate-specific antigen (PSA) and digital rectal exam (DRE) which can identify prostate cancer in the early stages. This may explain part of the increase in the prostate cancer incidence among New Jersey men between 1987 and 1992. The subsequent decline after the peak in 1992 may be due to the previous diagnosis of men who otherwise would have been diagnosed at a later date, a pattern which is typically seen when screening is widely implemented. The annual age-adjusted mortality rate of prostate cancer in New Jersey also peaked in 1993.

Throughout the period of 1979-1996, New Jersey trends closely mirrored those of the U.S.
Although we do not know why New Jersey incidence rates now appear to be slightly higher than those of the U.S., whereas they were previously slightly lower, that change may reflect improved completeness of reporting to the NJSCR

Differences Between White and Black Men in Recent Incidence and Mortality Trends

In New Jersey, white and black men have had parallel trends for prostate cancer incidence and mortality rates. The rates for black men have been much higher than those for whites, consistent with national trends. The higher mortality rates among black men may be explained by higher incidence in combination with a higher percentage of prostate cancers being diagnosed in the later stages. In addition, recent studies suggest that even within the same stages of diagnosis, the clinical features of prostate cancer tend to be of poorer prognosis in black men than in white men (Fowler and Bigler, 1999),


Issues and Recommendations on Prostate Cancer Screening:

It is clear from the trends shown above on incidence and stage at diagnosis in New Jersey and the U.S. that screening for prostate cancer, especially using PSA, has resulted in detection of early stage prostate cancer at higher rates. (Hankey et al, 1999). However, unlike screening for certain other cancers, such as mammography for breast cancer or Pap tests for cervical cancer, there are as yet no conclusive data that PSA screening decreases prostate cancer mortality in the long run. In fact, there is currently intense debate about the appropriate recommendations for the use and follow-up of PSA screening among different groups of men, according to their ages or according to the presence of risk factors such as a positive family history. Among the reasons for the debate are (1) the fact that PSA tests often give results suggesting prostate cancer in the absence of actual disease (false positives); (2) the difficulty in distinguishing which local prostate cancers are likely to progress to life-threatening malignancies and which are so slow-growing that they are unlikely to progress if left untreated; and (3) the medical and psychological burdens, side effects, and financial burdens which can be caused to patients by diagnosis and treatment procedures and their complications. There are currently carefully controlled studies (randomized clinical trials) under way which are following for many years men with and without PSA screening as part of their medical care.

In the meantime, the recommendations of the New Jersey Department of Health and Senior Services are the following:

All men over 50 years of age should have annual screening for prostate cancer. Men over 40 who are black or who are at high risk because of family history should also be screened annually. The screening tests should include DRE at a minimum and may include PSA. All men considering or having the screening tests should be fully informed about the implications of a positive test and the benefits and risks of treatment.

Other Recommendations

Since some studies indicate that avoidance of high fat diets and of obesity may be protective against developing prostate cancer, and since these health behaviors are widely accepted as preventing other diseases, the Department of Health and Senior Services recommends that diets low in fat and high in fruits and vegetables be followed.

Studies and Projects on Prostate Cancer at the Department of Health and Senior Services

Current studies and projects underway at this Department include:

  1. Collaboration on a case-control study of PSA screening and prostate cancer mortality
    with the University of Medicine and Dentistry of New Jersey / Robert Wood Johnson
    Medical School. The study aims to document whether PSA screening improves
    survival from prostate cancer.

  2. Geographic description of the areas where men are tending to be diagnosed at
    later stages of prostate cancer in order to direct outreach and education to citizens and
    health facilities in those areas.

  3. A special project to improve the quality of prostate cancer stage data and reporting
    from non-hospital sources.

Conclusions

Prostate cancer incidence has recently declined in New Jersey and the U.S. Although the incidence rate for black men is declining, they are still more likely than white men to get prostate cancer. Black men are more likely to be diagnosed at a later stage and are more likely to die of the disease. Additional research is needed on the causes and the means to prevent prostate cancer. At this time, early detection and treatment are the best methods to prevent premature mortality due to prostate cancer.


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